Marian F. Zeitlin

Maternal education and child feeding practices in rural Bangladesh.

This study in rural lowland Bangladesh used spot and event observations from 185 children aged 4-27 months in order to examine whether child feeding practices differed with mothers education and with household education. Each child and his/her caretakers were observed for a mean of 20 hr over 6 months from February to July 1986. Only 25% of mothers and 51% of fathers had had any formal education. Exploratory partial correlations and stepwise multiple regression analyses revealed significant behavioral differences with both maternal and household measures of education while controlling for wealth. Caretakers in families with education were found to feed the children more frequently, with fresher food, and in cleaner, more protected places. They did not allow their children to eat food intended for someone else as often, and were more observant when their childrens food dropped during the feeding. These caretakers also used more cups and bottles for feedings, breastfed their children less frequently, and their mothers terminated the breastfeedings more often. These behaviors suggested a shift from less attentive feeding practices and less frequent feedings to more frequent feedings in which the caretaker took more control of the childs feeding sessions. They also suggest a commitment to more labor-intensive child care. These associations between education and child feeding practices are mechanisms through which maternal education may improve child health and growth. They suggest the need for promoting more formal and nonformal education.

Maternal employment, child care, and nutritional status of 12-18-month-old children in Managua, Nicaragua

Relationships among womens employment, child care strategies, and nutritional status of children 12-18 months of age were examined in 80 Nicaraguan households sampled by randomized block design in 10 low income urban communities. Multiple regression analyses showed that children of employed mothers (56%) fared better in weight/height than those whose mothers were not employed, with and without controlling for socioeconomic status and maternal education, paternal financial support, child care adequacy, and sex and age of the child. Children with inadequate alternate child care (care by a preteen or care at the work place) had lower height for age, even controlling for the same variables and for maternal employment. Differences in 10 caregiving behaviors between families as a function of work status of the mother and adequacy of child care were examined. In families with working mothers, caregivers were less likely to be observed washing their hands, suggesting that the positive associations of work for earnings might be due to income rather than improved care. Inadequate care was associated with less food variety, less use of health care, and marginally less hand-washing. Inadequate child care, which tends to be associated with informal work, nuclear families and poverty, should be a concern for child welfare.

Field Validation of the Tallstick in Marginal Communities in Nicaragua

The Tallstick is a new, simplified anthropometric field tool which allows immediate visual interpretation of height-for-age. This tool was field tested in community-based programmes in Managua, Nicaragua, and the rural community of Los Zarzales, screening 1004 children aged 0-60 months for nutritional stunting. Overall sensitivity and specificity analysis comparing HAZ scores and Tallstick results revealed that the Tallstick correctly identified 83-85 per cent of severely stunted children (HAZ < -2.5) and two-thirds of those with HAZ of -2 and below. It also had good positive predictive value for the mildly stunted. As a screening tool for low weight-for-age, the Tallstick performed better than arm circumference. The best of the community volunteers trained with the Tallstick could use it as well as their trainers. Progressive stunting was found in the 280 children in the sample who did not receive any form of milk. The advantages of the Tallstick for community-level screening and the importance of sustained linear growth are discussed.

Assessment of the effects of teaching germ theory on changes in hygiene behaviors cleanliness and diarrheal incidence in rural Bangladesh.

Germ theory was taught as part of a hygiene intervention in five villages in Bangladesh in which 87 percent of mothers were illiterate. Volunteer mothers taught other community mothers interactively in small groups using demonstration and teaching aids developed by a community working group. At final measurement 91 percent of mothers could explain five simple messages defining germ theory. Using germ theory in groups they identified forty high risk day-to-day practices and modified them to reduce diarrheal transmission. They adopted these new hygiene practices at rates ranging from 65 percent to 100 percent. Regression analysis suggests that understanding of germ theory was an important determinant of hygiene practices, cleanliness, and reduction in diarrheal incidence. Understanding of germ theory appeared to reduce diarrheal incidence not only through the interventions designed by the project but also changing perceptions of risk in the environment which led to spontaneous improvement in hygiene behaviors. We believe that accurate understanding of causes, transmission, and prevention of disease can 1) empower community and individual actions; and 2) contribute significantly to the impact of hygiene interventions. Therefore, it may be imperative to integrate teaching germ theory into community health education.

The child development milestone chart ‐‐ An approach to low cost programming in Indonesia

As nutrition, growth monitoring and immunization programs have dramatically increased the rates of child survival throughout the developing world there has been a ground swell of interest in going beyond survival to increase childrens chances for optimal development. Past experience has shown that when developmental monitoring and stimulation programs are added to health and nutrition programs the rates of both physical and mental development may be improved. As a step toward a low cost developmental monitoring and early intervention program, a simple chart was developed in Indonesia. Based on the familiar growth monitoring chart and composed of items which are most predictive of long term developmental outcomes, the chart is designed to be used with existing nutrition or mother‐child welfare programs. For each developmental milestone in the first thirty‐six months of life the chart suggests simple stimulation activities which strengthen that milestone or encourage the child to achieve the next skill. Th...

An interactive dietary assessment method for use in rural Bangladesh Part I: Methodology for instrument development†

A 24‐hour dietary recall instrument that permits the interviewer to quantify calorie, protein and vitamin A intake on location was developed for use in rural Bangladesh. On this recall form, calories are summed with a tape measure. This paper presents the instrument and describes the methodology used for its development. The results of validation of the recall instrument against observed food intake are reported in “Part II: Evaluation.”

Comparison of Malnourished Children Selected by Weight-for-age, Mid-upper-arm Circumference, and Maximum Thigh Circumference

Although universal growth monitoring of preschool children in developing countries is a high priority scarce resources sometimes make it advisable to screen the community for malnutrition and to use growth chart monitoring for the subset of children who are at highest nutritional risk. This study contrasts equal numbers of children selected by arm circumference (AC) weight-for-age (W/A) and maximum thigh circumference (TC) screening from the same low income population in the Greater Manila area. The 3 indicators detect the same children 2/3 to 3/4 of the time. In the remaining 30-40% of cases the circumferences select a younger less stunted group than W/A. Study results suggest that the circumferences select children who are more malnourished with respect to their genetic potential or less well-adapted to an inadequate diet. They may be higher in W/A because they have more bone mass and more abdominal distension. At the same time they may have less muscle and fat tissue in proportion to height than those screened by W/A. W/A and W/H also fail to distinguish between large-boned thin children and small-boned less thin children. AC and TC appear to be sensitive to these distinctions. The quality and convenience of AC and TC should make them measures of choice for community screening of children under 5. Because AC and TC select proportionately younger children at earlier stages of malnutrition their use in screening may serve to prevent the occurrence of severe malnutrition between the ages of 2 and 5.

An interactive dietary assessment method for use in rural Bangladesh Part II: Evaluation†

An interactive dietary assessment method developed for use in rural Bangladesh was evaluated. Observed 24‐hour food intake of 10 mothers and their 10 infants was compared with the mothers recall on the following day. Cultural factors contributing to the accuracy of recall were the self‐sacrificing attentiveness of the mother, preoccupation with food caused by food scarcity, structured family meals, lack of platewaste, infrequency of snacking, simplicity of the diet and uniformity of utensils and serving and eating practices in rural homes. Differences in average intake reported by the two methods were very small. Measurement reliability and sources of error are presented.