Prof. Emeritus Mohd Ismail Noor, Faculty of …Study by Dr. Chen in 1984 reported nutritional status of 79 children < 12y) The study objective presented here is to explore factors

Bong MW, Nutritional Sciences Programme, Faculty of Health Sciences, UKM, Kuala Lumpur

Prof. Norimah A Karim, Nutritional Sciences Programme, Faculty of Health Sciences, UKM, Kuala Lumpur

Prof. Emeritus Mohd Ismail Noor, Faculty of Hospitality, Food and Leisure Management, Taylor’s University, Subang Jaya, Malaysia.

Introduction

• The global prevalence of stunting amongst children below five years was recorded at 22.9% in year 2016, with Malaysia recording a stunting prevalence of 17.7%.(UNICEF et al., 2017)

• The National Health and Morbidity Survey 2016 reported stunting among children below five years at 20.7%; and 23.1% for the state of Sarawak.(Aris et al., 2016)

Introduction

• The Third National Plan of Action for Nutrition, Malaysia contains specified targets to improve infant young child feeding practices and nutritional status of children (NCCFN, 2016).

• In addition, it has also been noted that there is a lack of data on quality of complementary feeding given to children in Malaysia (NCCFN, 2011).

• This study is part of an infant young child feeding research amongst Penan children aged below 24 months.

• Study was conducted in Belaga District, Sarawak.

There are an estimated 16,000 tribal Penans living in rural and remote

areas of Sarawak (Lyndon et al., 2013)

Earlier studies

A.J.U Anderson, 2015; Nutrition Research in Sarawak; 1970s – 1980s; Sarawak Medical Department Chen, 1984; Child Nutrition among the Penans of the Upper Baram, Sarawak, Med. J. Malaysia Vol. 39 No 4 (Study by Dr. Chen in 1984 reported nutritional status of 79 children < 12y)

The study objective presented here is to explore factors contributing to poor feeding practices amongst Penan children aged below 24 months.

Introduction

Methodology

• This qualitative study is part of a larger infant young child feeding research carried out in Belaga District, Sarawak beginning from 2016.

• Qualitative data collection was carried out in 2 localities in Belaga district, Sarawak between December 2016 to June 2017.

• Purposive sampling

• A total of 17 in-depth interviews were conducted.

• Respondents were Penan mothers with children aged below 24 months.

Methodology

• In-depth interviews were conducted inside the living room of respondents’ homes. Interviews were recorded after obtaining permission and also written consent from mothers.

• Recorded interviews were transcribed using ExpressScribe Pro transcription software version 6.04.

• Thematic analysis was carried out using Atlas.ti software version 8.1.3 and initial codes were generated and collated into sub-themes reflecting the main themes in this study.

Results (Socio-Demographic) n (%)

Child’s age 0-5 months 6-11 months 12-17 months 18-23 months

2 (11.8) 4 (23.5) 3 (17.6) 8 (47.1)

Mother’s age < 25 years 25-34 years 35-44 years

12 (70.6) 4 (23.5) 1 (5.9)

Mother’s education No formal schooling Primary school Secondary school

11 (64.7) 4 (23.5) 2 (11.8)

Household income category

Hard-core poor

17 (100)

1. Poor complementary feeding.

2. Observance of specific food taboos.

3. Communalistic food-sharing.

4. Mothers reporting limited access to food.

5. Low nutrition knowledge.

Results & Discussion

Complementary foods given consisted of local staples mainly rice and sago. More than half of respondents reported starting complementary foods at 6 months.

Theme 1. Poor complementary

feeding

Sub-theme • early complementary feeding • late introduction of foods from

animal-sources • feeding only vegetables when meat

was unavailable • feeding a limited variety of fruits and

vegetables

5 mothers started complementary foods as early as at 1 month, 3 months and at 5 months. Reasons given for early complementary feeding include their baby wanted to eat or mothers did not have enough breastmilk.


feeding




vegetables

Several mothers reported late introduction of animal-source foods; namely at 7 to 9 months and also at age 1 year. Reason given was because their child did not ask for it. Mothers also reported feeding only vegetables when meat was unavailable, meat meaning fish, pork or chicken.


feeding




vegetables

In terms of feeding vegetables, 11 mothers said vegetables are good for their children because it made their children healthy. However, only a limited variety of vegetables and fruits were given. 6 mothers reported giving only cassava shoots. Fruit given to children was banana.

Nearly 30% infants (4 to 5 months) are already fed solid foods (White et al., 2017). 67% mothers had given solid foods earlier than 4 months (Inayati et al., 2012). Intake of fruits and vegetables was low in several regions of the world, and at 29.2% in East Asia and Pacific region. Higher intake of fruits and vegetables was reported among children from urban areas and the richest households in all world regions (White et al., 2017).

Chicken was sometimes not available because mothers did not have money to buy chicken. Pork and fish was sometimes unavailable if men did not have a successful hunting or fishing trip. Another reason given was lack of means to go hunting or fishing, for example money to buy petrol and transportation.

Theme 2. Having limited access

to food

Sub-theme • difficulty in getting meat

• difficulty in getting fish

• difficulty in getting fruits and vegetables

When mothers were asked if their household had ever run out of rice, 6 mothers said yes. Furthermore 7 mothers reported difficulty getting food to be given to their children. Some said when meat and vegetables were unavailable, they would feed

plain porridge, with added salt.


to food




“An important dietary feature, was a frequent lack of leafy vegetable…” (Anderson, 2015).


to food




Reason given by mothers was sometimes vegetables planted did not thrive and the soil was hard. Banana was planted nearby longhouse.

9 mothers reported they did not give pork and also other meat like deer. Some refrained from giving for fear of child getting diarrhea; and some mothers said it was not usually eaten by themselves or forbidden by their mother (meaning the child’s grandmother). Certain types of fish which were perceived to be bony was also not given for fear child would choke.

Theme 3. Observance of

specific food taboos

Sub-theme • not feeding certain types of meat

and fish

• not feeding ferns and bitter vegetables

Negative attributes associated with animal source foods: fish had bones; fish might cause worm infestation or diarrhea; meat was hard to swallow (Rasheed et al., 2011)




and fish


Some mothers also reported not giving ferns due to it being strong smelling and might cause their child to vomit, if given in excess amounts. Besides ferns, bitter vegetables were also not given. The findings in this study are similar to earlier study, whereby lactating mothers avoided strong smelling foods, which mothers believed would pass into breastmilk and might cause diarrhea (Anderson, 2015)




and fish


Theme

4. Communalistic food-sharing is practiced, especially sharing of rice, pork and chicken meat. This practice has also been reported previously by Anderson, 2015 and Chen, 1984: whereby meat obtained via hunting would be divided equally between households.

In this study, food-sharing might be practiced among households belonging to extended family members only and not the entire longhouse. Nearly all mothers interviewed expressed positive views regarding food-sharing or traditional way of life, although there is awareness that their way of life is changing.

5. The fifth theme in this study is low nutrition knowledge. Some mothers reported not knowing what foods were good for their children, one mother also listed snack foods as good for her child. More information is needed by family members, not only regarding importance of not giving complementary foods before 6 months, but also information regarding suitable foods to be given (Thet et al., 2016)

Conclusion Factors contributing to poor feeding practices include inappropriate complementary feeding (starting solid foods too early, late introduction of animal-source foods, giving limited variety of vegetables and fruits).

In addition, low diet diversity and inadequate quantity of complementary foods was due to limited access to foods and food taboos.

Effort to improve feeding practices amongst children in this vulnerable population should also address food availability.

References 1. Anderson, A. (2015) Compilation of Nutrition Research (1970s - 1980s). Sarawak Health

Department, Ministry of Health Malaysia. 2. Aris, T., Fadillah, C., Abd, C., Farzana, F., Zaki, A., Hassan, H. M., Chong, J., Hasim, M. M., Rusydi, M.

and Radzi, M. (2016) National Health and Morbidity Survey (NHMS 2016): Maternal and Chid Health. Vol II: Findings. Available at: www.iku.gov.my.

3. Chen, P. C. Y. (1984) ‘Child nutrition among the Penans of the Upper Baram, Sarawak.’, Medical Journal of Malaysia, 39(4), pp. 264–268. doi: 10.3945/jn.114.191981.

4. Department of Statistics Malaysia (2017) Statistics Yearbook Sarawak. Kuching: Department of Statistics Malaysia. Available at: https://www.dosm.gov.my.

5. Inayati, D. A., Scherbaum, V., Purwestri, R. C., Hormann, E., Wirawan, N. N., Suryantan, J., Hartono, S., Bloem, M. A., Pangaribuan, R. V., Biesalski, H. K., Hoffmann, V. and Bellows, A. C. (2012) Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia, International breastfeeding journal. doi: 10.1186/1746-4358-7-3.

6. Lyndon, N., Er, A. C., Sivapalan, S., Ali, H., Rosniza, A. C. R., Azima, M. A., Junaidi, A. B., Fuad, M. J., Hussein, M. Y. and Mohd Helmi, A. R. (2013) ‘The world-view of Penan community on quality of life’, Asian Social Science, 9(14 SPL), pp. 98–105. doi: 10.5539/ass.v9n14p98.

7. NCCFN (2011) Nutrition Research in Malaysia: Selected Bibliography of Published Journal Articles from (1985-2010).

References 8. NCCFN (2016) National Plan of Action for Nutrition of Malaysia III. Available at:

http://nutrition.moh.gov.my/wp-content/uploads/2016/12/NPANM_III.pdf (Accessed: 14 November 2017).

9. Rasheed, S., Haider, R., Hassan, N., Pachón, H., Islam, S., Jalal, C. S. B. and Sanghvi, T. G. (2011) ‘Why does nutrition deteriorate rapidly among children under 2 years of age? Using qualitative methods to understand community perspectives on complementary feeding practices in Bangladesh’, Food and Nutrition Bulletin, 32(3), pp. 192–200.

10. Sercombe, P. G. (2008) ‘Small Worlds : the Language Ecology of the Penan in Borneo’, Encyclopaedia of Language and Education. 2nd Editio. Springer Science+Business Media LLC.

11. State Planning Unit (2013) Sarawak Facts and Figures 2013. Available at: http://www.spu.sarawak.gov.my/downloads/Facts & Figures/Sarawak Facts & Figures 2013.pdf.

12. Thet, M. M., Khaing, E. E., Diamond-Smith, N., Sudhinaraset, M., Oo, S. and Aung, T. (2016) ‘Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands’, Appetite. Elsevier Ltd, 96, pp. 62–69. doi: 10.1016/j.appet.2015.08.044.

13. UNICEF, World Health Organization; and World Bank Group (2017) Levels and Trends In Child Malnutrition, Joint Child Malnutrition Estimates. Available at: http://www.who.int/nutgrowthdb/jme_brochoure2017.pdf.

14. White, J. M., Bégin, F., Kumapley, R., Murray, C. and Krasevec, J. (2017) ‘Complementary feeding practices: Current global and regional estimates’, Maternal & Child Nutrition, 13(S2), p. e12505. doi: 10.1111/mcn.12505.

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Prof. Emeritus Mohd Ismail Noor, Faculty of …Study by Dr. Chen in 1984 reported nutritional status of 79 children < 12y) The study objective presented here is to explore factors