title: Infant and young child feeding in four departments in Haiti: mixed-method study on prevalence of recommended practices and related attitudes, beliefs, and other determinants.
abstract: OBJECTIVE
  To determine and describe the prevalence and patterns of three recommended practices for infant and young child feeding-exclusive breastfeeding (EB), continued breastfeeding (CB), and achievement of minimum dietary diversity-in four regions in Haiti, and to identify the attitudes and beliefs that inform these practices and any other factors that may facilitate or impede their implementation.
  
  
  METHODS
  This study utilized a mixed-methods approach consisting of 1) a cross-sectional survey (n = 310) and 2) 12 focus group discussions among women ≥18 years old with children ≤ 2 years old. Multivariable logistic regression analyses were conducted to identify factors associated with 1) EB during the first six months of life, 2) CB for children ≥ 2 years old, and 3) receipt of a diverse variety of complementary foods. Qualitative data were recorded, transcribed verbatim, and analyzed for common themes. Data were collected in June and July 2013 in four departments in Haiti: Artibonite, Nippes, Ouest, and Sud-Est.
  
  
  RESULTS
  Prevalence of EB, CB, and achievement of minimum dietary diversity was 57.0%, 11.9%, and 21.2% respectively. EB was statistically significantly associated with infant's age when controlling for annual household income, location of most recent birth, or receipt of CB counseling (odds ratio (OR) = 0.67 (95% CI: 0.47-0.97)). CB was not statistically significantly associated with rural place of residence, receipt of CB counseling, parity, or infant's age. Meeting minimum dietary diversity was not significantly associated with parity, receipt of postnatal care, rural place of residence, location of most recent birth, receipt of infant and young child feeding counseling, or level of schooling. Beliefs surrounding the relationship between the mother's health and her diet on the quality of breast milk may prohibit EB and CB. Qualitative data revealed that dietary diversity may be low because 1) mothers often struggle to introduce complementary foods and 2) those that are traditionally introduced are not varied and primarily consist of grains and starches.
  
  
  CONCLUSIONS
  Prevalence of the three recommended infant and young child feeding practices examined in this study is suboptimal, particularly CB and achievement of minimum dietary diversity. Future communication and programming efforts should address the misunderstandings and concerns identified through the qualitative methods used in this research.
authors.affiliation: Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America, alaterra@gwmail.gwu.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Laterra
authors.affiliation: Nutrition Section, UNICEF Country Office, Port-au-Prince, Haiti.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Ayoya
authors.affiliation: Nutrition Section, UNICEF Country Office, Port-au-Prince, Haiti.
authors.forename: Jean-Max
authors.initials: JM
authors.lastname: Beaulière
authors.affiliation: Nutrition Section, UNICEF Country Office, Port-au-Prince, Haiti.
authors.forename: M'mbakwa
authors.initials: M
authors.lastname: Bienfait
authors.affiliation: Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America, alaterra@gwmail.gwu.edu.
authors.forename: Helena
authors.initials: H
authors.lastname: Pachón
mesh_terms: D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002654:Child Care / Q000379:methods* / Q000523:psychology; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control; D002675:Child, Preschool; D004032:Diet; D006205:Haiti / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000523:psychology; D007225:Infant Food; D007228:Infant Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control; D009751:Nutritional Requirements; D015995:Prevalence; D012959:Socioeconomic Factors