Browsing by Subject "lisäruokinta"
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(2020)Varhaisravitsemus on elintärkeää lapsen selviytymisen ja kasvun, sekä terveeksi, yhteiskunnan tuotteliaaksi aikuiseksi kehittymisen kannalta. Aliravitsemus aiheuttaa vuosittain yli kolmen miljoonan alle viisivuotiaan kuoleman, ja suhteessa syntyneisiin kuolleisuus on suurinta Afrikassa. Vaikka lasten ravitsemuksen edistäminen on kansainvälisesti todettu prioriteetti, lähes puolet kaikista alle viisivuotiaiden kuolemista voidaan yhdistää epäoptimaaliseen ravitsemukseen. Imetyskäytäntöjen edistämiseksi on tehty paljon töitä, mutta lisäruokakäytäntöjä ja niiden kehittämistä on tutkittu vähemmän. Tämän pro gradu -tutkielman tavoitteena oli selvittää opetusvideoita nähneiden alle kaksivuotiaiden lasten äitien ja kontrolliäitien välisiä eroja lisäruokatiedoissa, -asenteissa ja -käytännöissä. Lisäksi tavoitteena oli raportoida alle kaksivuotiaiden lasten ruoankäyttöä tutkimusalueilla. Tämä tutkielma on osa Helsingin yliopiston GloCal-projektia, jonka tarkoituksena oli kehittää naisten ja lasten terveyttä ja ravitsemusta edistävä opetusvideosetti. Keniassa kuvatut 47 swahilinkielistä videota olivat nähtävissä kuuden kuukauden ajan äideille ja lapsille suunnattujen terveyskeskusten odotustiloissa Nairobissa slummialueella ja Machakosin maaseutualueella Keniassa. Aineisto kerättiin poikkileikkausasetelmassa intervention lopussa syksyllä 2016. Kenialaiset ravitsemustieteilijät haastattelivat alle kaksivuotiaiden lasten äitejä paikallisella kielellä. Kaikki tilastolliset analyysit tehtiin IBM Statistics SPSS (versio 24) -ohjelmalla. Haastattelun aloitti 1005 henkilöä, joista 66 keskeytti haastattelun ja 40 ei täyttänyt sisäänottokriteereitä (n=965). Lasten ruokavalio koostui molemmilla alueilla pääasiassa viljoista, hedelmistä ja kasviksista. Proteiinipitoisten ruokien saanti oli vähäistä. Vain noin joka kymmenes kaikista 6–8 kuukauden ikäisistä ja alle puolet kaikista 9–23 kuukauden ikäisistä lapsista täytti WHO:n lisäruokinnan vähimmäissuositukset (MAD). Nairobin interventioryhmässä (NI) ateriatiheys, MF (6−8 kk p=0,002; 9−11 kk p<0,001 ja 12−23 kk p=0,002) ja ruokavalion monipuolisuus, DDS (ikäryhmittäin: p=0,025; p=0,002 ja p=0,013) olivat paremmat kuin kontrolliryhmässä (NK). Machakosin interventioryhmässä (MI) DDS oli parempi vanhimmassa ikäryhmässä (p=0,023) verrattuna kontrolliryhmään (MK). NI:ssä MAD oli keskimäärin parempi kuin NK:ssä (9−11 kk p=0,002 ja 12−23 kk p=0,022). NI:ssä lapset saivat yleisemmin lihaa, kalaa ja mereneläviä (ikäryhmittäin: p=0,017; p=0,001 ja p=0,007) ja öljyä (ikäryhmittäin: p=0,001; p<0,0001 ja p=0,002) verrattuna NK:ään. NI:n asenteet lisäruokien aloitusajankohtaan (p=0,006) sekä munien (p=0,001), palkokasvien (p<0,001), kalan (p=0,037) ja hedelmien (p=0,048) antamiseen puolivuotiaalle lapselle liittyen olivat paremmat verrattuna NK:ään. MI:n asenteet palkokasvien (p=0,011) ja kalan (p=0,013) päivittäisen tarpeellisuuden suhteen olivat paremmat kuin MK:ssä. Äitien tietämys ruokaryhmistä (hedelmät ja kasvikset p<0,0001 ja palkokasvit p=0,046), eläinperäisten tuotteiden hyödyistä (lapsen kehitys p=0,003 ja aivojen kehitys p=0,030) ja puuron sopivasta koostumuksesta (p<0,001) oli NI:ssä parempi kuin NK:ssä. Ryhmien välillä oli selvästi useampia tilastollisesti merkitseviä eroja Nairobissa kuin Machakosissa, ja alueellisten erojen selvittäminen olisikin hyvä jatkotutkimusaihe. Tutkielma osoittaa, että opetusvideoilla on potentiaalia edistää äitien lisäruokakäytäntöjä, -tietoja ja asenteita. Lisää tutkimusta kuitenkin tarvitaan esimerkiksi selvittämään äitien mahdollinen tuen tarve. Lisäksi vastaavien videoiden tutkiminen kontrolloiduissa olosuhteissa antaisi tarpeellista lisätietoa videoiden tehosta.
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(2020)Varhaisravitsemus on elintärkeää lapsen selviytymisen ja kasvun, sekä terveeksi, yhteiskunnan tuotteliaaksi aikuiseksi kehittymisen kannalta. Aliravitsemus aiheuttaa vuosittain yli kolmen miljoonan alle viisivuotiaan kuoleman, ja suhteessa syntyneisiin kuolleisuus on suurinta Afrikassa. Vaikka lasten ravitsemuksen edistäminen on kansainvälisesti todettu prioriteetti, lähes puolet kaikista alle viisivuotiaiden kuolemista voidaan yhdistää epäoptimaaliseen ravitsemukseen. Imetyskäytäntöjen edistämiseksi on tehty paljon töitä, mutta lisäruokakäytäntöjä ja niiden kehittämistä on tutkittu vähemmän. Tämän pro gradu -tutkielman tavoitteena oli selvittää opetusvideoita nähneiden alle kaksivuotiaiden lasten äitien ja kontrolliäitien välisiä eroja lisäruokatiedoissa, -asenteissa ja -käytännöissä. Lisäksi tavoitteena oli raportoida alle kaksivuotiaiden lasten ruoankäyttöä tutkimusalueilla. Tämä tutkielma on osa Helsingin yliopiston GloCal-projektia, jonka tarkoituksena oli kehittää naisten ja lasten terveyttä ja ravitsemusta edistävä opetusvideosetti. Keniassa kuvatut 47 swahilinkielistä videota olivat nähtävissä kuuden kuukauden ajan äideille ja lapsille suunnattujen terveyskeskusten odotustiloissa Nairobissa slummialueella ja Machakosin maaseutualueella Keniassa. Aineisto kerättiin poikkileikkausasetelmassa intervention lopussa syksyllä 2016. Kenialaiset ravitsemustieteilijät haastattelivat alle kaksivuotiaiden lasten äitejä paikallisella kielellä. Kaikki tilastolliset analyysit tehtiin IBM Statistics SPSS (versio 24) -ohjelmalla. Haastattelun aloitti 1005 henkilöä, joista 66 keskeytti haastattelun ja 40 ei täyttänyt sisäänottokriteereitä (n=965). Lasten ruokavalio koostui molemmilla alueilla pääasiassa viljoista, hedelmistä ja kasviksista. Proteiinipitoisten ruokien saanti oli vähäistä. Vain noin joka kymmenes kaikista 6–8 kuukauden ikäisistä ja alle puolet kaikista 9–23 kuukauden ikäisistä lapsista täytti WHO:n lisäruokinnan vähimmäissuositukset (MAD). Nairobin interventioryhmässä (NI) ateriatiheys, MF (6−8 kk p=0,002; 9−11 kk p<0,001 ja 12−23 kk p=0,002) ja ruokavalion monipuolisuus, DDS (ikäryhmittäin: p=0,025; p=0,002 ja p=0,013) olivat paremmat kuin kontrolliryhmässä (NK). Machakosin interventioryhmässä (MI) DDS oli parempi vanhimmassa ikäryhmässä (p=0,023) verrattuna kontrolliryhmään (MK). NI:ssä MAD oli keskimäärin parempi kuin NK:ssä (9−11 kk p=0,002 ja 12−23 kk p=0,022). NI:ssä lapset saivat yleisemmin lihaa, kalaa ja mereneläviä (ikäryhmittäin: p=0,017; p=0,001 ja p=0,007) ja öljyä (ikäryhmittäin: p=0,001; p<0,0001 ja p=0,002) verrattuna NK:ään. NI:n asenteet lisäruokien aloitusajankohtaan (p=0,006) sekä munien (p=0,001), palkokasvien (p<0,001), kalan (p=0,037) ja hedelmien (p=0,048) antamiseen puolivuotiaalle lapselle liittyen olivat paremmat verrattuna NK:ään. MI:n asenteet palkokasvien (p=0,011) ja kalan (p=0,013) päivittäisen tarpeellisuuden suhteen olivat paremmat kuin MK:ssä. Äitien tietämys ruokaryhmistä (hedelmät ja kasvikset p<0,0001 ja palkokasvit p=0,046), eläinperäisten tuotteiden hyödyistä (lapsen kehitys p=0,003 ja aivojen kehitys p=0,030) ja puuron sopivasta koostumuksesta (p<0,001) oli NI:ssä parempi kuin NK:ssä. Ryhmien välillä oli selvästi useampia tilastollisesti merkitseviä eroja Nairobissa kuin Machakosissa, ja alueellisten erojen selvittäminen olisikin hyvä jatkotutkimusaihe. Tutkielma osoittaa, että opetusvideoilla on potentiaalia edistää äitien lisäruokakäytäntöjä, -tietoja ja asenteita. Lisää tutkimusta kuitenkin tarvitaan esimerkiksi selvittämään äitien mahdollinen tuen tarve. Lisäksi vastaavien videoiden tutkiminen kontrolloiduissa olosuhteissa antaisi tarpeellista lisätietoa videoiden tehosta.
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(2019)Infant undernutrition with associated diseases is a leading cause of under-five deaths globally, causing 45% of child deaths. A critical point for the nutritional status of the infant is the time when the first foods are introduced in addition to breastfeeding, i.e. complementary feeding. Based on prior research, complementary feeding practices are inadequate in East Africa, including Uganda. Particular concerns are the not timely introduction of complementary foods and low dietary diversity of children under two years. Complementary feeding is a complex set of behaviours. Good complementary feeding comprises, in addition to nutritious food itself, the feeding moment, technique and style. The promotion of good complementary feeding practices therefore demands multiple approaches. The aim of this study was to explore complementary feeding perceptions and practices in the context of the Health Belief Model (HBM) and to gain understanding on how to promote health behaviour change for better complementary feeding. The study was carried out in the rural area of Kirewa, Uganda. All together 9 focus group discussions (FGD) were held for caretakers of children under two: mothers, fathers, grandfathers and grandmothers. A set of educational videos on infant care and feeding practices, the GloCal-videos, were used as a projective tool in the FGDs. In addition, one individual interview with the local health care worker was conducted. The data from the FGDs and the interview were analysed with a deductive content analysis method based on the HBM. The findings from this research demonstrate that complementary feeding practices among the study participants were suboptimal in relation to timing, dietary diversity, consistency and feeding frequency. The importance of complementary feeding as a health behaviour preventing malnutrition and stunting was not understood among these Kirewan caretakers. The findings from the HBM based analysis suggest messages about the susceptibility of children to detrimental consequences of poor feeding and their seriousness should be targeted to caretakers. Based on this study, the GloCal-videos may work as cues to action for better complementary feeding practices.
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(2016)Chronic undernutrition, or stunting, reduces the growth and development of about one third of the world’s children less than five years of age. The consequences of chronic undernutrition may be long-lasting and irreversible and it increases the risk of death. Undernutrition is the most prevalent at the age of 6–24 months when breast milk no longer meets the energy and nutrient needs of the growing child. Complementary foods in low- and middle income countries are often inadequate nutritionally or in amounts. There are also a wide variety of behavioural aspects critical for child nutrition and well-being. Style of complementary feeding may be an important determinant of dietary intake and nutritional status. The caregiver-infant interaction can influence infant’s nutritional status. Interpreting child’s ques responsively can enhance the acceptance of food. Caregiver feeding styles can be classified as controlling, laissez-faire or responsive. Laissez-faire feeding style is common in societies where children are stunted. Encouraging the child is especially important during illness when appetite is often diminished. The aim of this study is to investigate the feeding and caring practices of children in rural area of Southern Benin where 45% of children under five are chronically undernourished. The behavioural aspects of breast feeding and complementary feeding and the caregiver-infant interaction are discussed. The research was conducted in two rural villages in the Mono region where 30 households were randomly selected. Of the households 30 mothers of children aged 6–23 mo were selected to participate in a semi-structured interview. Purposeful sampling was used to get the same amount of children in three age groups; 6–8 mo, 9–11 mo and 12–23 mo. Mother-child pairs (n=20) and the feeding situations were observed after the interviews. Data was coded and analysed using content and thematic analysis. Methodological, data and researcher triangulation improves the validity of the study. Children in the rural area of Southern Benin were not fed according to WHO recommendations. Children were not exclusively breastfed for 6 mo as the majority of children were given traditional medicine or water after birth. However, children were breastfed beyond the age of two in addition to getting other liquids and foods. The average starting age of complementary foods was 4.7 mo [0–12 mo]. The diet typically consisted of maize gruel or porridge that was usually eaten with green leafy vegetables. Children rarely got animal-source foods. Mothers reported ways to encourage children if they refuse to eat. However, children were seldom encouraged to eat during the ob-served feeding situations and only a few mothers spoke to their child when feeding. There were signs of controlling feeding style in the villages. Not many children were encouraged in self-feeding. Many caregivers showed behaviours of all the feeding styles and thus it could not be categorized as strictly responsive, laissez-faire or controlling. During illnesses breastfeeding was reduced as well as giving liquids and other foods. After illnesses only about a fifth of the mothers reported increasing complementary feeding. Hygienic practices could be improved as few mothers washed their own or child’s hands before eating. A good example of some mother’s hygienic practices was, however, washing the child before the meal.
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(2013)While a situational analysis by an intervention research program CoS-SIS was being conducted in Lawra and Nadowli regions in Northern Ghana, it was noticed that some farms performed differently: they had more animals, better market off-take or they employed uncommon practices. This raised an interest in this kind of behaviour; what kind of positive deviance exists and what enables it? The objective of this study was to gain understanding on enabling factors for better livelihood outcomes. Study design was a case study where positive deviant (PD) and commercial farmers were contrasted to regular farmers. Qualitative ethnographic methods were used in data collection. Semi-structured interviews with open-ended questions were conducted with the main 12 PD informants. Recorded and transcribed data was analyzed by using thematic content analysis. The findings suggest that subsistence production is most common while commercial farming is rare. Recreational farming exists as well. Only commercials sell animals in sales purposes; commonly animals are sold only in need. The main constraints refer to animal mortality, stealing and lack of water. At the back of the problems there are insufficient service delivery and input dealing as well as farmers’ identity and attitudes towards animal rearing. Positive deviance manifests in larger animal holdings and areas in cultivation. This is attributed to the practices employed: PDs offer supplementary feeding, vaccinate and deworm the animals as well as house them for the night. The practices have been learned through neighbours and relatives as well as through extension and projects. Characteristics to PDs is an off-farm income source which enables investments in agriculture. It can be concluded that PD is about basic practices which have been learned from rather common sources. Creating an enabling environment for small ruminant production requires institutional changes as regards to farmers’ attitudes and service and input delivery. Local practices as responses to constraints would be suitable topics for further research.
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(2022)Background and aim Complementary feeding is defined as the period during which there is a progressive reduction of breastfeeding or formula while the infant is gradually introduced to solid foods at 4-6 months of age. Improper complementary feeding practices, such as introducing solid foods beyond 6 months of age or having a low dietary diversity could lead to negative infant health outcomes. Therefore, it is important to identify factors that might detrimentally affect complementary feeding, such as maternal stress. This thesis aimed to study the associations between maternal stress indicators, the age of solid food introduction, and dietary diversity during complementary feeding within a Finnish birth cohort. Methods The Health and Early Life Microbiota (HELMi) is a longitudinal birth cohort study. Participants of the HELMi cohort included 1055 healthy infants and their parents, mainly residing in the capital region of Finland. Pre-collected data from the HELMi study were used. The data collection occurred between 2016-2018. The main variables used in this thesis were collected via extensive online questionnaires. Binomial logistic regression analyses were used to study whether prenatal and postpartum stress indicators were associated with the age of solid food introduction and/or the infant’s dietary diversity during complementary feeding. Results Late introduction of solid foods (> 6 months) was less likely among infants whose mothers reported moderate or high prenatal stress (moderate prenatal stress OR=0.66, 95%CI 0.45-0.97, high prenatal stress OR 0.62, 95%CI 0.39-0.98), when compared to infants whose mothers reported low prenatal stress. Maternal stress indicators were not associated with low dietary diversity (0-3 food groups introduced) at 6 months of life. Among infants with a low dietary diversity at 9 months of age, mothers were more likely to report high levels of prenatal stress (OR=4.88, 95%CI 1.27-18.79), when compared to mothers with low levels of prenatal stress. Further, infants with a low dietary diversity at 9 months were less likely to have mothers report low to moderate levels of life satisfaction (OR=0.25, 95%CI 0.06-1.02) when compared to mothers with very high life satisfaction. They were also less likely to report moderate levels of infant health worry (OR=0.18, 95%CI 0.05-0.67) when compared to mothers with no infant health worry. Conclusions This is the first study to look at the associations between maternal stress indicators and dietary outcomes during complementary feeding. Maternal stress indicators were associated with the age of solid food introduction and the infant’s dietary diversity at 9 months, but not at 6 months. In future studies on this topic, a more socio-demographically representative sample should be recruited, and validated tools should be used to collect dietary and psychological data. Health practitioners and family clinic workers should be made aware of the possibly long-lasting effects of prenatal stress and consider its possible effects on dietary outcomes during complementary feeding.
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(2022)Background and aim Complementary feeding is defined as the period during which there is a progressive reduction of breastfeeding or formula while the infant is gradually introduced to solid foods at 4-6 months of age. Improper complementary feeding practices, such as introducing solid foods beyond 6 months of age or having a low dietary diversity could lead to negative infant health outcomes. Therefore, it is important to identify factors that might detrimentally affect complementary feeding, such as maternal stress. This thesis aimed to study the associations between maternal stress indicators, the age of solid food introduction, and dietary diversity during complementary feeding within a Finnish birth cohort. Methods The Health and Early Life Microbiota (HELMi) is a longitudinal birth cohort study. Participants of the HELMi cohort included 1055 healthy infants and their parents, mainly residing in the capital region of Finland. Pre-collected data from the HELMi study were used. The data collection occurred between 2016-2018. The main variables used in this thesis were collected via extensive online questionnaires. Binomial logistic regression analyses were used to study whether prenatal and postpartum stress indicators were associated with the age of solid food introduction and/or the infant’s dietary diversity during complementary feeding. Results Late introduction of solid foods (> 6 months) was less likely among infants whose mothers reported moderate or high prenatal stress (moderate prenatal stress OR=0.66, 95%CI 0.45-0.97, high prenatal stress OR 0.62, 95%CI 0.39-0.98), when compared to infants whose mothers reported low prenatal stress. Maternal stress indicators were not associated with low dietary diversity (0-3 food groups introduced) at 6 months of life. Among infants with a low dietary diversity at 9 months of age, mothers were more likely to report high levels of prenatal stress (OR=4.88, 95%CI 1.27-18.79), when compared to mothers with low levels of prenatal stress. Further, infants with a low dietary diversity at 9 months were less likely to have mothers report low to moderate levels of life satisfaction (OR=0.25, 95%CI 0.06-1.02) when compared to mothers with very high life satisfaction. They were also less likely to report moderate levels of infant health worry (OR=0.18, 95%CI 0.05-0.67) when compared to mothers with no infant health worry. Conclusions This is the first study to look at the associations between maternal stress indicators and dietary outcomes during complementary feeding. Maternal stress indicators were associated with the age of solid food introduction and the infant’s dietary diversity at 9 months, but not at 6 months. In future studies on this topic, a more socio-demographically representative sample should be recruited, and validated tools should be used to collect dietary and psychological data. Health practitioners and family clinic workers should be made aware of the possibly long-lasting effects of prenatal stress and consider its possible effects on dietary outcomes during complementary feeding.
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