title: Nutritional Deficiencies, the Absence of Information and Caregiver Shortcomings: A Qualitative Analysis of Infant Feeding Practices in Rural China.
abstract: OBJECTIVE
  Development during the first two years of life is critical and has a lasting impact on a child's health. Poor infant and child nutrition can lead to deficiencies in essential micronutrients, which may cause a weakened immune system and lasting effects on children's growth and development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children's nutritional deficiencies through qualitative analysis. This study aims to elucidate some of the fundamental causes of poor complementary feeding practices that may lead to anemia among children in rural Shaanxi Province, China.
  
  
  METHODS
  We interviewed sixty caregivers participating in a large survey on child health and nutrition. We conducted three waves of interviews with children's primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province.
  
  
  RESULTS
  The qualitative analysis reveals that poor complementary feeding practices are common across our sample. Information gathered from our interviews suggests that complementary feeding practices are impeded by two constraints: absence of understanding topics related to infant health and nutrition under caregivers, as well as inadequate sources of information on these topics. Poverty does not appear to constrain child feeding practices.
  
  
  CONCLUSIONS
  Our results uncover lack of proper knowledge on infant and child nutrition among rural caregivers in China. This situation causes them to fail incorporating micronutrient rich foods in their children's diet. Age-appropriate complementary feeding can stimulate children's physical and cognitive development, but in its absence it leads to iron-deficiency anemia. We suggest that steps be taken to educate caregivers to improve complementary feeding of their infants and children.
authors.affiliation: Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an, Shaanxi, 710119, China.
authors.forename: Ai
authors.initials: A
authors.lastname: Yue
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, Sichuan, 610041, China.
authors.forename: Lauren
authors.initials: L
authors.lastname: Marsh
authors.affiliation: West China School of Public Health, Sichuan University, Chengdu, Sichuan, 610041, China.
authors.forename: Huan
authors.identifier: http://orcid.org/0000-0002-6709-5134
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, United States of America.
authors.forename: Alexis
authors.initials: A
authors.lastname: Medina
authors.affiliation: School of Advanced Agricultural Sciences, Peking University, Beijing, 100871, China.
authors.forename: Renfu
authors.initials: R
authors.lastname: Luo
authors.affiliation: Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an, Shaanxi, 710119, China.
authors.forename: Yaojiang
authors.initials: Y
authors.lastname: Shi
authors.affiliation: School of Advanced Agricultural Sciences, Peking University, Beijing, 100871, China.
authors.forename: Linxiu
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, United States of America.
authors.forename: Kaleigh
authors.initials: K
authors.lastname: Kenny
authors.affiliation: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Rozelle
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000503:physiopathology; D017028:Caregivers; D002657:Child Development / Q000502:physiology*; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000503:physiopathology; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D012423:Rural Health; D012424:Rural Population; D012959:Socioeconomic Factors