title: Maternal Literacy, Facility Birth, and Education Are Positively Associated with Better Infant and Young Child Feeding Practices and Nutritional Status among Ugandan Children.
abstract: BACKGROUND
  Understanding maternal factors that influence child feeding is necessary to inform intervention planning in settings in which mothers experience substantial social vulnerabilities.
  
  
  OBJECTIVE
  The purpose of this study was to assess maternal sociodemographic factors that may constrain women's caring capabilities and subsequent child nutrition in Uganda.
  
  
  METHODS
  We analyzed data from the 2006 and 2011 Uganda Demographic and Health Surveys to model the associations between maternal sociodemographic factors, child feeding practices, and anthropometry with multivariate logistic regression models.
  
  
  RESULTS
  The proportion of children fed according to recommended guidelines declined in Uganda from 2006 to 2011. Mothers who lacked literacy skills were less likely to achieve recommended complementary feeding indicators; however, literacy was not associated with breastfeeding practices. Mothers in the upper 60% wealth percentile were more likely to meet minimum meal frequency, diversity, and adequacy indicators. Mothers who gave birth at health facilities (2006 OR: 0.49; 95% CI: 0.26, 0.91; P < 0.05) and who were in the upper 60% wealth percentile (2011 OR: 0.43; 95% CI: 0.21, 0.69) were less likely to exclusively breastfeed until 6 mo. There were no significant associations between age at first pregnancy, maternal education, and infant and young child feeding practices. Women with a formal education had children with lower stunting and underweight probabilities in both time periods (OR range: 0.43-0.74). Women who delivered in childbirth facilities were less likely to have a child with low weight-for-age, length-for-age, or weight-for-length z scores (OR range: 0.59-0.82). Marital status, the age at first child birth, not accepting domestic violence, freedom to travel away from home, and involvement in household and reproductive decisions were not associated with child anthropometry in either time period.
  
  
  CONCLUSIONS
  Mothers with low literacy skills, who deliver their children at home, and who lack formal education are particularly at risk of poor child feeding and represent a group that may benefit from enhanced interventions that address their particular vulnerabilities. Factors that contribute to improved maternal feeding capabilities but may impair breastfeeding practices need to be better understood.
authors.affiliation: Department of Kinesiology and Health Sciences, College of William and Mary, Williamsburg, VA; and sbickes@wm.edu.
authors.forename: Scott B
authors.identifier: http://orcid.org/0000-0003-1025-4509
authors.initials: SB
authors.lastname: Ickes
authors.affiliation: Department of Kinesiology and Health Sciences, College of William and Mary, Williamsburg, VA; and.
authors.forename: Taylor E
authors.initials: TE
authors.lastname: Hurst
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Flax
mesh_terms: D000886:Anthropometry; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D006130:Growth Disorders / Q000517:prevention & control; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D000067010:Literacy; D016015:Logistic Models; D008297:Male; D009035:Mothers; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011247:Pregnancy; D012959:Socioeconomic Factors; D013851:Thinness / Q000517:prevention & control; D014454:Uganda
keywords: Uganda; breastfeeding; infant and young child feeding; maternal literacy; maternal social factors