title: Beyond food insecurity: how context can improve complementary feeding interventions.
abstract: BACKGROUND
  The role of context has not been elaborated with respect to current recommendations for complementary feeding interventions, apart from a gross distinction based on food security.
  
  
  OBJECTIVE
  Our objective was to compare two food-insecure settings in sub-Saharan Africa to determine how context (i.e., the set of local social, cultural, and physical circumstances) influences complementary feeding practices and nutrient intakes and how the results can help in the design of a suitable intervention strategy.
  
  
  METHODS
  We conducted formative research using 24-hour dietary recalls, household interviews, and focus group discussions with mothers of 6- to 12-month-old infants in rural Zimbabwe (n = 32) and Pemba Island, Zanzibar, Tanzania (n = 44).
  
  
  RESULTS
  In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and poor hygiene. Breastfeeding practices were poor in Pemba, and the infants' diet had low energy density in Zimbabwe. Beyond food insecurity, contextual determinants of practices included inaccurate indigenous knowledge, time-consuming maternal livelihoods, family eating behaviors, local agriculture, and the local ecosystem. Both settings would require nutrition education, but it should target the broader indigenous ways of learning and family eating behaviors in order to achieve the necessary behavior change. A home-based fortificant would probably be enough for Pemban children, because the ecosystem of the island provides sufficient sources of macronutrients. However, Zimbabwean children appear to need a fortified food-based supplement to overcome the poor agricultural and economic context.
  
  
  CONCLUSIONS
  Assessing context was essential to intervention design. A framework to guide future formative research is proposed.
authors.affiliation: Cornell University, Ithaca, New York 14853, USA. khp9@cornell.edu
authors.forename: Keriann H
authors.initials: KH
authors.lastname: Paul
authors.forename: Monica
authors.initials: M
authors.lastname: Muti
authors.forename: Sabra S
authors.initials: SS
authors.lastname: Khalfan
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.forename: Rosemary
authors.initials: R
authors.lastname: Caffarella
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
mesh_terms: D004032:Diet; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007407:Interviews as Topic; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D009035:Mothers / Q000193:education; D009751:Nutritional Requirements; D009752:Nutritional Status; D015995:Prevalence; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D015030:Zimbabwe / Q000453:epidemiology