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      Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets

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          Abstract

          Smallholder farmers dependent on rain‐fed agriculture experience seasonal variations in food and nutrient availability occasioned by seasonality of production patterns. This results in periods of nutrient abundance in the plenty seasons followed closely by periods of nutrient inadequacies and malnutrition. This pattern contributes to a cycle of deteriorating health and nutrition status and deprives children of their ability to realize full developmental potential. This study investigates the role of caregiver's nutritional knowledge and attitudes in mediating effects of seasonality on children's diets. Repeated cross‐sectional surveys were conducted on 151 randomly selected households in the plenty and lean seasons to collect dietary data using two non‐consecutive quantitative 24‐hr recalls and caregiver's nutritional knowledge and attitudes assessed using interviewer administered questionnaire. Sixty‐five percent of the caregivers had attained a primary level education or less. There was a positive modest correlation between caregivers' nutritional knowledge and their attitudes ( r = 0.3, P < 0.000, α = 0.01). Children's mean adequacy ratio was significantly higher in the plenty season than in the lean season (0.84 vs. 0.80, P < 0.000). A two‐block hierarchical regression to predict the seasonal changes in dietary quality of children using caregiver's nutritional knowledge and attitude scores while controlling for the effect of sociodemographics and mean adequacy ratio at first season (plenty) found that caregiver's nutritional knowledge (ß = −0.007, SE = 0.003, P = 0.027, 95% CI [−0.013, −0.001] ŋ 2 = 0.034) but not attitudes had significant contribution to the prediction. Maternal nutritional knowledge mediates seasonal variation in child nutrient intakes.

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          Most cited references24

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Effect of mother’s education on child’s nutritional status in the slums of Nairobi

            Background Malnutrition continues to be a critical public health problem in sub-Saharan Africa. For example, in East Africa, 48 % of children under-five are stunted while 36 % are underweight. Poor health and poor nutrition are now more a characteristic of children living in the urban areas than of children in the rural areas. This is because the protective mechanism offered by the urban advantage in the past; that is, the health benefits that historically accrued to residents of cities as compared to residents in rural settings is being eroded due to increasing proportion of urban residents living in slum settings. This study sought to determine effect of mother’s education on child nutritional status of children living in slum settings. Methods Data are from a maternal and child health project nested within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The study involves 5156 children aged 0–42 months. Data on nutritional status used were collected between October 2009 and January 2010. We used binomial and multiple logistic regression to estimate the effect of education in the univariable and multivariable models respectively. Results Results show that close to 40 % of children in the study are stunted. Maternal education is a strong predictor of child stunting with some minimal attenuation of the association by other factors at maternal, household and community level. Other factors including at child level: child birth weight and gender; maternal level: marital status, parity, pregnancy intentions, and health seeking behaviour; and household level: social economic status are also independently significantly associated with stunting. Conclusion Overall, mothers’ education persists as a strong predictor of child’s nutritional status in urban slum settings, even after controlling for other factors. Given that stunting is a strong predictor of human capital, emphasis on girl-child education may contribute to breaking the poverty cycle in urban poor settings.
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              Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children.

              We estimated the variability among nations in the prevalence of stunting and wasting, evaluated which national factors are associated with stunting and wasting and examined the relationship of stunting with wasting. The World Health Organization Global Database on Child Growth, a comprehensive conceptual model and a database of national factors were used with variance components and regression analyses. There was substantial variability among nations and among provinces within nations. Most national variability for stunting (76%) and wasting (66%) was explained by national factors and geographic region. Higher energy availability, female literacy and gross product were the most important factors associated with lower prevalence of stunting. The association of health expenditures and stunting differed by region. Higher immunization rate and, for Asia only, energy availability were the most important factors associated with lower prevalence of wasting. Regional differences in the relationship between stunting and wasting were accounted for by national factors. Some factors associated with stunting and wasting differ at the national level. Child malnutrition within a household is greatly influenced by issues at national and provincial levels, and intervention should be considered at all three levels.
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                Author and article information

                Contributors
                francodhis@gmail.com
                Journal
                Matern Child Nutr
                Matern Child Nutr
                10.1111/(ISSN)1740-8709
                MCN
                Maternal & Child Nutrition
                John Wiley and Sons Inc. (Hoboken )
                1740-8695
                1740-8709
                03 July 2018
                January 2019
                : 15
                : 1 ( doiID: 10.1111/mcn.2019.15.issue-1 )
                : e12633
                Affiliations
                [ 1 ] Healthy Diets from sustainable food Systems Initiative Bioversity International Nairobi Kenya
                [ 2 ] Healthy Diets from Sustainable Food Systems Initiative Bioversity International Rome Italy
                [ 3 ] Department of Human Nutrition, Faculty of Health Sciences Egerton University Nakuru Rift Valley Kenya
                Author notes
                [*] [* ] Correspondence

                Francis Odhiambo Oduor, Healthy Diets from Sustainable Food Systems Initiative, Bioversity International, c/o ICRAF, UN‐Avenue Gigiri, Nairobi, Kenya.

                Email: francodhis@ 123456gmail.com

                Author information
                http://orcid.org/0000-0001-8082-6387
                http://orcid.org/0000-0001-8654-8760
                Article
                MCN12633 MCN-11-17-OA-2883.R1
                10.1111/mcn.12633
                6859406
                29968334
                d2adae02-bad0-4255-bc37-e6823a399536
                © 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 10 November 2017
                : 26 March 2018
                : 22 May 2018
                Page count
                Figures: 2, Tables: 5, Pages: 10, Words: 5474
                Funding
                Funded by: Biovision Foundation ‐ Switzerland
                Funded by: HumidTropics CGIAR Research program
                Funded by: Agriculture for Nutrition and Health
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                January 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:18.11.2019

                attitudes,children,kenya,micronutrient intakes,nutrition knowledge,seasonality

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