Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study


Autoři: Mekonnen Haileselassie aff001;  Getachew Redae aff001;  Gebretsadik Berhe aff001;  Carol J. Henry aff003;  Michael T. Nickerson aff004;  Bob Tyler aff004;  Afework Mulugeta aff001
Působiště autorů: School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia aff001;  Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia aff002;  College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada aff003;  Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225707

Souhrn

Background

Animal source foods provide high-quality protein and essential micronutrients within the human diet and are of particular significance for the health and development of children. Despite the availability of domestic livestock in rural households of Ethiopia, the diets of children are often monotonous and mainly cereal-based with low energy and nutrient density.

Objective

Explore barriers and facilitators for the consumption of animal source foods among 6–23 months old children from the rural communities of Northern Ethiopia.

Methods

A community-based exploratory qualitative study design was conducted in July through September 2018. A total of eight focus group discussions (56 individuals) and twenty-four qualitative interviews were conducted with mothers who are lactating, fathers, health extension workers, nutrition, and agriculture experts. Purposive sampling technique was used to include study participants based on their potential relevance in delivering a wealth of information. Thematic analysis strategies, a method for identifying, analyzing, and reporting themes within data, were used to code and grouped into related families and synthesize the qualitative data.

Results

Consumption of animal source foods among 6–23 months old children was very low and the home-reared livestock and their products were mainly used for market purposes. Animal products are consumed during special societal occasions since they are considered as luxury food rather than an essential part of daily children’s diet. Lack of nutrition knowledge, high cost of animal source foods, mothers’ workload to herd livestock, low household income, low milk production, the poor linkage between health and agriculture sectors, and social norms and beliefs were identified as common barriers. While the presence of nutrition experts, cooking demonstrations, in-kind credit programs, livestock ownership, and government-led stunting reduction programs were the facilitators for the consumption of animal source foods in the study communities.

Conclusions

Reduced consumption of animal source foods inadvertently impacted dietary diversity of 6–23 months old children from the study communities. Thus, strengthening social and behavior change communication to promote the consumption of animal source foods, creating opportunities for women to own small livestock for household consumption and provide nutrition education on dietary restriction of animal source foods during religious periods among 6–23 months old children in the rural communities of Northern Ethiopia are recommended.

Klíčová slova:

Agriculture – Food consumption – Children – Livestock – Meat – Milk – Mothers – Nutrition


Zdroje

1. Sigman M, McDonald MA, Neumann C, Bwibo N. Prediction of cognitive competence in Kenyan children from toddler nutrition, family characteristics, and abilities. J Child Psychol Psychiatry. 1991; 32: 307–20. doi: 10.1111/j.1469-7610.1991.tb00309.x 1903401.

2. Heinbuch U. Animal Protein Sources for Rural and Urban Populations in Ghana. Program for the Integrated Development of Artisanal Fisheries in West Africa, Cotonou, IDAF/WP/58. 1994.

3. Krebs N, Westcott JE, Butler N, Robinson C, Bell M, Hambidge KM. Meat as a first complementary food for breastfed infants: feasibility and impact on zinc intake and status. J Pediatr Gastroenterol Nutr. 2006; 42: 207–214. doi: 10.1097/01.mpg.0000189346.25172.fd 16456417.

4. Neumann C, Harris DM, Rogers LM. Contribution of animal source foods in improving diet quality and function in children in the developing world. Nutr Res. 2002; 22: 193–220.

5. Siekmann J, Allen LH, Bwibo NO, Demment MW, Murphy SP, Neumann CG. Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. J Nutr. 2003; 133: 3972S–80S. doi: 10.1093/jn/133.11.3972S 14672298.

6. Neumann C, Murphy SP, Gewa C, Grillenberger M, Bwibo NO. Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children. J Nutr. 2007; 137: 1119–23. doi: 10.1093/jn/137.4.1119 17374691.

7. Grillenberger M, Neumann CG, Murphy SP, Bwibo NO, Weiss RE, Jiang L, et al. Intake of micronutrients high in animal source foods is associated with better growth in rural Kenyan school children. Br J Nutr. 2006; 95: 379–90. doi: 10.1079/bjn20051641 16469157.

8. Mallard S, Houghton LA, Filteau S, Mullen A, Nieuwelink J, Chisenga M, et al. Dietary diversity at 6 months of age is associated with subsequent growth and mediates the effect of maternal education on infant growth in urban Zambia. J Nutr. 2014; 144: 1818–1825. doi: 10.3945/jn.114.199547 25332481.

9. Murphy S, Allen LH. Nutritional importance of animal source foods. J Nutr. 2003; 133: 3932S–5S. doi: 10.1093/jn/133.11.3932S 14672292.

10. Central Statistical Agency (CSA), Federal Democratic Republic of Ethiopia, Agricultural Sample Survey. Volume II, Report on livestock and livestock characteristics. 2016/17, Addis Ababa.

11. Kibrom T, Ibrahim W. Consumption Patterns of Livestock Products in Ethiopia: Elasticity Estimates Using HICES (2004/05) Data. Ethiopia Strategy Support Program II (ESSP II) Working Paper 38. Addis Ababa, Ethiopia, May 2012.

12. Eshetie T, Hussien K, Teshome T, Mekonnen A. Meat production, consumption and marketing tradeoffs and potentials in Ethiopia and its effect on GDP growth: a review. J Nutr Health Food Eng. 2018; 8(3): 228‒233. doi: 10.15406/jnhfe.2018.08.00274

13. Temesgen M. Nutritional status of Ethiopian weaning and complementary foods: a review. Open Access Sci Rep. 2013; 2(2): 1–9. doi: 10.4172/scientificreports.621

14. Betru S, Kawashima H. Pattern and determinants of meat consumption in urban and rural Ethiopia. LIVESTOCK RES RURAL DEV. 2009; 21(143): Retrieved November 30, 2018, from http://www.lrrd.org/lrrd21/9/betr21143.htm.

15. Hanna B, Eva-Charlotte E, Magnus J, Yemane B, Christopher T, Beatrix W, et al. What Influences Urban Mothers’ Decisions on What to Feed Their Children Aged Under Five-The Case of Addis Ababa, Ethiopia. Nutrients 2018; 10: 1142; doi: 10.3390/nu10091142 30135354.

16. EDHS, Central Statistics Agency. Ethiopian Demographic and Health Survey, Addis Ababa. 2016.

17. Christiaensen L, Alderman H. Child malnutrition in Ethiopia: can maternal knowledge augment the role of income? Econ Dev Cult Change. 2004; 52(2): 287–312.

18. EDHS, Central Statistics Agency. Mini Ethiopian Demographic and Health Survey, Addis Ababa. 2019.

19. Ministry of Health (MOH). Program Implementation Manual of National Nutrition Program; Ministry of Health (MOH): Addis Ababa, Ethiopia, 2016.

20. Ministry of Health (MOH). The Seqota Declaration: A Government of Ethiopia Commitment to End Child Undernutrition in Ethiopia by 2030; Ministry of Health (MOH): Addis Ababa, Ethiopia, 2016.

21. Saunders M, Lewis P, Thornhill A. Research Methods for Business Students 6th edition, Pearson Education Limited, 2012.

22. Ministry of Health (MOH). Ethiopia Federal Ministry of Health. Health Sector Development Programme-IV2011. 2011. Available online: http://www.nationalplanningcycles.org/sites/default/files/country_docs/Ethiopia/ethiopia_hsdp_iv_final_draft_2010_-2015.pdf. Accessed September 6, 2018.

23. L iamputtong P, Ezzy D. Qualitative Research Methods. Melbourne: Oxford University Press; 2005. doi: 10.1016/j.ymeth.2005.03.001

24. Yelena W, Deborah T, Karen A, Elizabeth M, Janet D. Commentary: Writing and Evaluating Qualitative Research Reports. J Pediatr Psychol. 2016; 41(5): 493–505. doi: 10.1093/jpepsy/jsw032 27118271.

25. Wong P. Focus group discussion: a tool for health and medical research. Singapore Med J. 2008; 49(3): 256–261; quiz 261. 18363011.

26. Guest G.M.K, Namey E.E. Applied Thematic Analysis, SAGE Publications, Inc., 2012, pp. 320.

27. Abraha A, Myle´us A, Byass P, Kahsay A, Kinsman J (2019) Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia. PLoS ONE 14(6): e0218101. doi: 10.1371/journal.pone.0218101 31194787

28. Gemechu K, Endalkachew T, Mulatu A. Dietary diversity and associated factors among children of Orthodox Christian mothers/caregivers during the fasting season in Dejen District, North West Ethiopia. Nutrition & Metabolism 2018; 15: 16. doi: 10.1186/s12986-018-0248-0 29456587.

29. Ethiopian Public Health Institute. Ethiopia National Food Consumption Survey, Addis Ababa, Ethiopia, 2013. https://www.ephi.gov.et/images/pictures/National%20Food%20Consumption%20Survey%20Report_Ethiopia.pdf. Accessed September 6, 2018.

30. Nyantakyi-Frimpong H, Colecraft Esi K, Awuah R, Adjorlolo K, Wilson L, Jones A. Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana. Soc Sci Med. 2018; 212: 191–202. doi: 10.1016/j.socscimed.2018.07.028 30041091.

31. Chingala G, Mapiye C, Raffrenato E, Hoffman L, Dzama K. Determinants of smallholder farmers' perceptions of impact of climate change on beef production in Malawi. Climatic Change 2017; 142; (1–2): 129–141.

32. Christian A, Marquis G, Colecraft Esi K, Lartey A, Sakyi-Dawson O, Ahunu B, et al. Caregivers’ nutrition knowledge and attitudes are associated with household food diversity and children’s animal source food intake across different agro-ecological zones in Ghana. Br J Nutr. 2016; 115: 351–360. doi: 10.1017/S0007114515004468 26560016.

33. Colecraft E, Marquis G.S, Aryeetey R, Sakyi-Dawson O, Lartey A, Ahunu B, et al. Constraints on the use of animal source foods for young children in Ghana: a participatory rapid appraisal approach. Ecol. Food Nutr. 2006; 45(5): 351–377.

34. Mukta U.S, Chakraborty B, Sayka U, Haque Md.R, Mia Md.M.U. Identified Factors Behind Low Consumption of Animal Foods among the Children of 6–23 Months Old in Alive and Thrive Intervention Areas in Bangladesh. Open Access Library Journal 2015; 2: e1452. http://dx.doi.org/10.4236/oalib.1101452.

35. Bwibo N, Neumann CG. The need for animal source foods by Kenyan children. J Nutr. 2003; 133(11 suppl 2): 3936S–40S. doi: 10.1093/jn/133.11.3936S 14672293.

36. Alive & Thrive, 2010. IYCF practices, beliefs, and influences in Tigray Region, Ethiopia Alive & Thrive, Addis Ababa, Ethiopia. 2010.

37. Abebe Z, Abebe G, Haki K. Health extension workers’ knowledge and knowledge-sharing effectiveness of optimal infant and young child feeding are associated with mothers’ knowledge and child stunting in Rural Ethiopia. Food Nutr Bull. 2016; 37(3): 353–363. doi: 10.1177/0379572116651209 27272483.

38. Creed‐Kanashiro H, Wasser H, Bartolini R, Goya C, Bentley M. Formative research to explore the acceptability and use of infant food grinders for the promotion of animal source foods and micronutrient powders in rural Peru. Matern Child Nutr. 2018; e12600. doi: 10.1111/mcn.12600 29608250.

39. Iannotti L. L, Robles M, Pachón H, Chiarella C. Food prices and poverty negatively affect micronutrient intakes in Guatemala. J Nutr. 2012; 142(8): 1568e1576. doi: 10.3945/jn.111.157321 22695968.

40. Cornelsen L, Alarcon P, Häsler B, Amendah D, Ferguson E, Fèvre E, et al. Cross-sectional study of drivers of animal source food consumption in low-income urban areas of Nairobi, Kenya. BMC Nutr. 2016; 2: 70.

41. Hoddinott J, Headey D, Dereje M. Cows, missing milk markets, and nutrition in rural Ethiopia. Journal of Development Studies 2015; 51(8): 958–975. https://doi.org/10.1080/00220388.2015.1018903.

42. Fantu B, Minten B, Feiruz Y. The rising costs of animal source foods in Ethiopia: Evidence and implications. Strategy support program working paper 108, August 2017. Addis Ababa: Ethiopian Development Research Institute.

43. Monika G, Charlotte G, Neumann P, Murphy O, Bwibo E, Weiss J, et al. Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children. Br J Nutr. 2006; 95: 379–390. doi: 10.1079/bjn20051641 16469157.

44. McLean E, Allen LH, Neumann CG, Peerson JM, Siekmann JH, Murphy SP, et al. Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods. J Nutr. 2007; 137: 676–682. doi: 10.1093/jn/137.3.676 17311959.

45. Gittelsohn J, Vastine A. Sociocultural and Household Factors Impacting on the Selection, Allocation, and Consumption of Animal Source Foods: Current Knowledge and Application. J Nutr. 2003; 133: 4036S–4041S. doi: 10.1093/jn/133.11.4036S 14672308.

46. Kim S, Nguyen P, Tran L, Yewelsew A, Yonas A, Tharaney M, et al. Maternal behavioral determinants and livestock ownership are associated with animal source food consumption among young children during fasting in rural Ethiopia. Matern Child Nutr. 2018; e12695. wileyonlinelibrary.com/journal/mcn. doi: 10.1111/mcn.12695 30230233

47. Pachón H, Simondon K, Fall S, Menon P, Ruel M, Hotz Ch, et al. Constraints on the delivery of animal-source foods to infants and young children: Case studies from five countries. Food Nutr Bull. 2007; 28(2). doi: 10.1177/156482650702800211 24683681.

48. Getachew A, Ibrahim H, Minten B. Consumption of Animal-source Foods in Ethiopia: Patterns, Changes, and Determinants. Strategy support program, working paper 113, January 2018, Ethiopia.

49. Kabir A, Maitrot MRL. Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study. PLoS ONE 2017; 12(2): e0172119. doi: 10.1371/journal.pone.0172119 28207894.

50. Njuki JM, Wyatt A, Baltenweck I, Yount K, Null C, Ramakrishnan U, et al. An Exploratory study of Dairying Intensification, Women’s Decision Making, and Time Use and Implications for Child Nutrition in Kenya. EUR J DEV RES. 2015; 2: 1–19.

51. Randolph T, Schelling E, Grace D, Nicholson CF, Leroy JL, Cole DC, et al. Invited Review: Role of livestock in human nutrition and health for poverty reduction in developing countries. J Anim Sci. 2007; 85: 2788–2800. doi: 10.2527/jas.2007-0467 17911229.

52. Beruk B, Lambert C, Riedel S, Tegene N, Biesalski H. Ethiopian Orthodox Fasting and Women who are lactating: Longitudinal Study on Dietary Pattern and Nutritional Status in Rural Tigray, Ethiopia. Int. J. Environ. Res. Public Health 2018; 15(1767). doi: 10.3390/ijerph15081767 30126089.

53. Bazzano AN, Potts KS, Mulugeta A. How do pregnant and lactating women, and young children, experience religious food restriction at the community level? A qualitative study of fasting traditions and feeding behaviors in four regions of Ethiopia. PLoS ONE 2018; 13(12): e0208408. doi: 10.1371/journal.pone.0208408 30517203.

54. Kaitlin S, Potts KS, Afework M, Bazzano AN. Animal source food consumption in young children from four regions of Ethiopia: association with religion, livelihood, and participation in the Productive Safety Net Program. Nutrients 2019; 11, 354; doi: 10.3390/nu11020354 30743994.

55. Nakachew M, Shifera A, Abebe M, Yared M, Netsanet F. Barriers and facilitators of child-feeding practice in a small sample of individuals from Gozamin District, Northwest of Ethiopia: a qualitative study. BMC Nutr. 2018; 4: 25.

56. Kumar N, Eshetie A, Kebede E, Abebe N. Productive and Reproductive Performance of Local Cows under Farmer’s Management in and around Gondar, Ethiopia. Int. J. Livest. Res. 2014; 4(6).

57. Mulugeta A, Belayeneh A. Reproductive and lactation performances of dairy cows in Chacha Town and nearby selected kebeles, North Shoa Zone, Amhara Region, Ethiopia. World Journal of Agricultural Sciences 2013; 1(1): 008–017.

58. Mekasha A, Gerard B, Tesfaye K, Nigatu L, Duncan AJ. Inter-connection between land use/land cover change and herders’/farmers’ livestock feed resource management strategies: a case study from three Ethiopian eco-environments. AGR ECOSYST ENVIRON. 2014; 188: 150–162.

59. Andualem T. A review on cattle husbandry practices in Ethiopia. Int. J. Livest. Prod. 2016; 7(2): 5–11.

60. Benson T. Cross-sectoral coordination failure: how significant a constraint in national efforts to tackle malnutrition in Africa? Food Nutr Bull. 2007; 28(2 Suppl): 323–30. doi: 10.1177/15648265070282S211 17658078.

61. Girmay A, Tesfaye H, Desalegn K, Andinet A, Solomon E, Alemnesh P. et al. Linkages between health and agriculture sectors in Ethiopia: a formative research study exploring barriers, facilitators and opportunities for local level coordination to deliver nutritional programmes and services. BMC Nutr. 2017; 3(69).

62. SPRING.2007. Zambia: Nutrition-sensitive Agriculture in Practice. Review of approaches and experience in three development activities. Arlington, VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project 2017.

63. Sanghvi T, Martin L, Hajeebhoy N, Teweldebrhan H, Yewelsew A, Haque R. Strengthening systems to support mothers in infant and young child feeding at scale. Food Nutr Bull. 2013; 34(3). doi: 10.1177/15648265130343S203 24261074.

64. Alive & Thrive. Ethiopia infant and young child feeding media and materials: multi-media and training package. Addis Ababa, Ethiopia. 2012.

65. Ghosh S, Tano-Debrah K, Aaron G, Otoo G, Strutt N, Bomfeh K, et al. Improving complementary feeding in Ghana: reaching the vulnerable through innovative business-the case of KOKO Plus. Ann. N.Y. Acad. Sci. 2014; 1331: 76–89. doi: 10.1111/nyas.12596 25514865.

66. SPRING. 2016. Nigeria: Complementary Feeding and Food Demonstration Training Complementary Feeding Manual. Arlington, VA: Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project. 2016.

67. Nisbetta N, Boldb M, Gillespieb S, Menonc P, Davisd P, Roopnarained T, et al. Community-level perceptions of drivers of change in nutrition: Evidence from South Asia and sub-Saharan Africa. Global Food Security 2017; 13: 74–82.

68. Rawlins R, Pimkina S, Barrett C.B, Pedersen S, Wydick B. Got milk? The impact of Heifer International's livestock donation programs in Rwanda on nutritional outcomes. Food Policy 2014; 44: 202–213.

69. Ayele Z, Peacock C. Improving access to and consumption of animal source foods in rural households: the experiences of a women-focused goat development program in the highlands of Ethiopia. J Nutr. 2003; 133(11): 3981S–3986S. doi: 10.1093/jn/133.11.3981S 14672299.

70. Azzarri C, Zezza A, Haile B, Cross E. Does livestock ownership affect animal source foods consumption and child nutritional status? Evidence from rural Uganda. The Journal of Development Studies 2015; 51(8): 1034–1059. https://doi.org/10.1080/00220388.2015.1018905.

71. Dumas S, Kassa L, Young SL, Travis AJ. Examining the association between livestock ownership typologies and child nutrition in the Luangwa Valley, Zambia. PLoS ONE 2018; 13(2): e0191339. doi: 10.1371/journal.pone.0191339 29408920


Článek vyšel v časopise

PLOS One


2020 Číslo 1