Association between caregivers' beliefs and practices regarding feeding of young children during diarrheal illness in Lima, Peru

Introduction: Malnutrition and diarrhea remain important global public health problems (1). As children who are adequately fed during diarrhea recover faster, continuing normal feeding is included in the WHO guidelines for treatment of childhood diarrhea (2). To investigate the association between caregivers' beliefs and practices regarding child nutrition during diarrhea we conducted a study in a poor peri-urban community in Lima, Peru. Methods: 390 caregivers and children (≤36 months) were included. In a questionnaire caregivers' practices and beliefs regarding child nutrition in the absence and presence of diarrhea were assessed. An educational intervention about adequate nutrition during diarrhea was conducted after the interview. Follow-up was performed three months later. Multivariate analysis was used to determine associations between beliefs, socio-economics and practices. Results: Before the intervention 75% of caregivers would give „no food“, „less food“ or „a special diet“, low in calories, proteins and vitamins. At follow-up the percentage of caregivers who would give „the same“ or „more“ food increased to 76%. Initially 24% of caregivers believed food to be harmful during diarrhea. This dropped to 2% after the intervention. Logistic regression revealed that the belief „food is damaging during diarrhea“ was associated with a higher risk of giving a „special diet“ while believing that „food helps the child to get well“ was associated with a lower risk of giving a „special diet“ when controlling for factors such as caregiver's age, level of education, money spent on food and living location. Conclusion: A considerable percentage of caregivers did not adequately feed their children during diarrhea. Caregivers who believed that food was harmful were more likely to feed their children a special diet, lacking important nutrients. Caregivers' practices and beliefs improved significantly after the educational intervention. Long-term educational programs addressing caregivers' concerns regarding child nutrition during diarrhea are urgently needed.

Literatur:

1. Guerrant RL, Oriá RB, Moore SR, Oriá MO, Lima AA. Malnutrition as an enteric infectious disease with long-term effects on child development. Nutr Rev. 2008 Sep;66(9):487–505. 2. WHO, UNICEF. IMCI chart booklet – standard. 2008. http://www.who.int/child_adolescent_health/documents/IMCI_chartbooklet/en/index.html