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.
In 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)
In 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)
Introduction In The study objective presented here is to explore factors contributing to poor feeding practices amongst Penan children aged below 24 months.
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 (S (Socio-Demographic) n (%) Child’s age 0-5 months 2 (11.8) 6-11 months 4 (23.5) 12-17 months 3 (17.6) 18-23 months 8 (47.1) Mother’s age < 25 years 12 (70.6) 25-34 years 4 (23.5) 35-44 years 1 (5.9) Mother’s education No formal schooling 11 (64.7) Primary school 4 (23.5) Secondary school 2 (11.8) Household income Hard-core poor 17 (100) category
Results esults & & Dis Discussi cussion on 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.
Theme Sub-theme • early complementary feeding 1. Poor complementary • late introduction of foods from feeding animal-sources • feeding only vegetables when meat was unavailable • feeding a limited variety of fruits and vegetables Complementary foods given consisted of local staples mainly rice and sago. More than half of respondents reported starting complementary foods at 6 months.
Theme Sub-theme • early complementary feeding 1. Poor complementary • late introduction of foods from feeding 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.
Theme Sub-theme • early complementary feeding 1. Poor complementary • late introduction of foods from feeding animal-sources • feeding only vegetables when meat was unavailable • feeding a limited variety of fruits and 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.
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% in infants (4 (4 to 5 month ths) are alr lready fed solid id foods (W (White et t al ., ., 2017). . 67% moth thers had giv iven solid id foods earlie lier th than 4 month ths (In (Inayati i et t al ., ., 2012). . In Intake of f fr fruits its and vegetable les was lo low in in several regio ions of f th the world ld, and at t 29.2% in in East t Asia ia and Pacif ific ic regio ion. . Hig igher in intake of f fr fruits its and vegetables was reported among child ildren fr from urban areas and th the ric ichest t households in in all ll world ld regio ions (Whit ite et t al ., ., 2017).
Theme Sub-theme • difficulty in getting meat 2. Having limited access to food • difficulty in getting fish • difficulty in getting fruits and vegetables 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 Sub-theme 2. Having limited access • difficulty in getting meat to food • 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.
Theme Sub-theme • difficulty in getting meat 2. Having limited access to food • difficulty in getting fish • difficulty in getting fruits and vegetables Reason given by mothers was sometimes vegetables planted did not thrive and the soil was hard. Banana was planted nearby longhouse. “An important dietary feature, was a frequent lack of leafy fy vegetable …” (Anderson, 2015).
Theme Sub-theme • not feeding certain types of meat 3. Observance of specific food taboos and fish • not feeding ferns and bitter vegetables 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 Sub-theme • not feeding certain types of meat 3. Observance of specific food taboos and fish • not feeding ferns and bitter vegetables Negativ ive attrib ibutes associa iated with animal source foods: fish had bones; fish might cause worm infestation or or diarrhea; meat was hard to to swall llow (Rasheed et et al al., 2011)
Theme Sub-theme • not feeding certain types of meat 3. Observance of specific food taboos and fish • not feeding ferns and bitter vegetables 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)
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)
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