Maternal empowerment is linked to improved child nutrition and infant and young child feeding (IYCF) practices, particularly in the first 1000 days of a child’s life [1–4]. The focus of women’s empowerment is often on ‘intrahousehold decision-making power,’ with access to greater decision-making power within the household presumably leading to improved nutrition-related decisions for their […]

Breastfeeding self-efficacy (BSE), defined as a mother’s confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.

Background: Prenatal anaemia causes serious consequences for both mother and foetus, and dietary factors are suggested to be associated with anaemia. However, research in pregnant women living in rural areas is limited. We aim to assess the contribution of dietary diversity to the magnitude of prenatal anaemia in rural China and identify the interactions between dietary diversity and several sociodemographic and maternal characteristics in relation to anaemia. Methods: A multi-stage random cluster sampling method was used to select pregnant women in rural western China. The Woman’s Dietary Diversity Score was created to measure dietary diversity, which was recoded into terciles. Multinomial logistic regression models were used to assess the associations between dietary diversity score terciles and the magnitude of prenatal anaemia. Multiplicative interactions were tested by adding the product term of dietary diversity and several sociodemographic and maternal characteristics into the regression models. Results: Out of 969 participants, 54.3% were measured as anaemic, with 28.6% mildly anaemic and 25.7% moderately to severely anaemic. There was an absence of agreement between self-reported and measured anaemia status (κ = 0.28, 95% CI [0.22–0.34]). Participants in the highest dietary diversity score tercile had lower odds of being moderately to severely anaemic after adjusting for potential confounders (RRR = 0.65, 95% CI [0.44, 0.98]). In participants with moderate to severe anaemia, significant interactions were found between dietary diversity score terciles, age, and parity (p for interaction < 0.05). Conclusions: The prevalence of prenatal anaemia in rural China remains high, and pregnant women living in these areas are insufficiently aware of their anaemia status. Improving dietary diversity is needed to manage prenatal anaemia in rural areas.

Infants born small for gestational age (SGA) remains a significant global public health concern, with potential interconnections among maternal diet, pre-pregnancy BMI, gestational weight gain (GWG), and SGA. This prospective study investigated the association between dietary diversity (DD) during pregnancy and the risk of SGA, as well as the synergistic effect of DD with pre-pregnancy BMI and GWG on SGA. Maternal dietary intake during pregnancy was assessed using 24 h dietary recalls, and dietary diversity scores (DDS) were calculated based on the FAO’s Minimum Dietary Diversity for Women index. Infant information was followed up. The Poisson regression model was employed to determine the association between maternal DD and SGA. Interactions between DD and pre-pregnancy BMI or GWG were evaluated under additive and multiplicative models. Among the 560 singleton live births, 62 (11.07%) were classified as SGA. After adjusting for potential confounders, the DDS exhibited a protective effect against SGA (aRR: 0.76; 95% CI: 0.62–0.95). DD modified the association between being underweight prior to pregnancy and SGA on the additive scale (interaction contrast ratio = 7.39; 95% CI: 5.84, 8.94). These findings suggest that improving dietary diversity during pregnancy, particularly among women with a low pre-pregnancy BMI, may be a feasible strategy to reduce the risk of SGA newborns.

• Understanding the ethnic gap in protective behavior adoption and its explanatory factors is a promising step for reducing pandemic-induced disparities. • Differences in socioeconomic status, fearfulness levels, degree of knowledge held about COVID-19, and self-efficacy levels appear to contribute to explaining the Han-minority protective behavioral gap in rural China. • Targeted, group-specific COVID-19 preventative messages may help to enhance individual confidence in coping with the pandemic while creating a healthy amount of fear for COVID-19.

Micronutrient powder (MNP or Yingyangbao, a dietary supplement that contains multiple vitamins and minerals) programs can reduce the risk of anemia among children. One such program in China distributed free MNP to children aged 6–24 months in poor rural areas. However, there are indications that the generation of primary caregiver (i.e., parent or grandparent) may influence MNP feeding behavior. The purpose of this study was to investigate the prevalence and influencing factors of effective MNP feeding behavior among parents and grandparents in a rural developing setting. We conducted a cross-sectional study of 884 caregivers and children in formerly impoverished rural areas of Sichuan Province using multi-stage random sampling. Data were collected on caregivers’ MNP feeding behavior, their core perceptions and health beliefs about MNP, children’s responses to MNP, MNP delivery patterns, and demographic characteristics. Influencing factors of parents’ and grandparents’ MNP feeding behavior were analyzed using two-level logistic regression. Total effective MNP feeding behavior rate among caregivers was 40.95%. Grandparents demonstrated higher MNP adoption than parents (χ2 = 4.445, P = 0.035). After controlling for sociodemographic characteristics, grandparents were more likely than parents to achieve effective MNP adoption (OR = 1.360, P = 0.035); child’s preference for MNPs (ORparental subgroup = 1.736, ORgrandparental subgroup = 1.496; P < 0.050) and caregiver’s self-efficacy (ORparental subgroup = 1.157, ORgrandparental subgroup = 1.393; P < 0.050) were influencing factors of feeding behavior for caregivers of both generations. Parents were also influenced by perceived barriers to feeding MNPs (OR = 0.904, P = 0.040), while grandparents were more strongly influenced by child’s discomfort to MNPs (OR = 0.240, P = 0.023) and caregiver’s knowledge about MNPs (OR = 1.557, P = 0.014). Future efforts to improve the feeding behavior of caregivers in MNP programs both in China and abroad should improve children’s preference for MNP by changing its composition and taste, and increase caregivers’ feeding self-efficacy through health education. Moreover, parents should be taught to cope with time and ability barriers that may limit MNP adoption, while grandparents should be emphasized the importance and potential side effects of MNP.