Presenter: Ms. Nikhat Shaikh Co-authors: Ms, Rijuta Sawant Ms. Sushmita Das Ms. Sonali Patil Ms. Sushma Shende Dr. Anuja Jayaraman

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
1st December 2021
Presenter: Ms. Nikhat Shaikh
Co-authors: Ms, Rijuta Sawant
Ms. Sushmita Das
Ms. Sonali Patil
Ms. Sushma Shende
Dr. Anuja Jayaraman
Understanding child nutrition during
the pandemic
A qualitative study of mothers of under-two children from
urban informal settlement of Mumbai
SNEHA: Society for Nutrition, Education & Health Action

2. • Adverse impact of COVID-19 pandemic is forecasted on both the provision and utilization of
health (RMNCH) services
• Poverty and food insecurity are likely to affect children’s ability to access health, education,
nutrition, water and sanitation and other essential services
Rationale
• To explore growth-promoting behaviors and practices of mothers of less than two years old
children during the pandemic in an urban slum of Mumbai.
• To understand the reasons for these growth promoting behaviors and practices.
Objective

3. Profile of respondents (N = 25)
Demography status of Children
Age 80% were 13-24 months old
Sex 60% were female
Nutritional status 44% were malnourished before and during the pandemic
Parental characteristics
Mothers 76% were between 20-29 years
48% had no or primary education
All mothers were homemakers
Fathers 76% were employed in informal sector
96% experienced loss of wages during lockdown
Family characteristics
Type of family 36% belonged to joint families
36% belonged to large nuclear families (more than 5 members)
28% belonged to small nuclear families
Migration 56% of the families migrated (temporary) to native places during lockdown

4. Themes explored:
• Mothers feeding and hygiene practices during
pandemic
• Role of other family members in child rearing
• Mothers views on their child’s health status
• Support from health workers during the
pandemic
Analysis:
• Data was coded using Nvivo10 software
• Data sorted thematically extracting themes -
using an iterative process of data reduction
Study period: June - September 2021
Design: Exploratory qualitative study
Sampling: Purposively sampled based on nutritional
status (wasting) of child as assessed before and
during the pandemic
2 groups:
• Group 1- Children whose nutritional status
improved (malnourished to normal status) and
children who continued to thrive (remained normal)
• Group 2- Children who remained malnourished
Method of data collection:
• In-depth interviews
• 25 telephonic interviews with mothers of less than
two year old children
Methods

5. “No we did not give outside food to her, kaise
denge kabhi wo bimar hogayi to dawai kidhar
se karayege, sab sochna padta hai, bahaar ka
kuch nahi diye yeh dar sai.” [Mother aged 30
years , no schooling, housewife]
“I did not let children go outside at all, if they go
out they used to wear masks and after coming
home I used to tell them to wash their hands
and legs carefully. I did not let them eat outside
things.” (Mother aged 27 years, no schooling,
housewife)
• Restricted Consumption of junk food: Home
cooked food, financial hardships
• Improved cooking, hygiene and sanitation
practices: Fed home cooked food ensuring
vegetables are washed carefully, maintaining
hand hygiene, followed COVID Approriate
Behaviour
• Benefits of complementary feeding:
Acknowledged benefits of complementary
feeding resulting in better child health
Group 1- Children who improved or sustained normal nutritional status
Reported growth promoting behaviours and practices

6. “
Here in village there are other children also, so she eats
with them. In Mumbai she does not ate much. Yahan
baccho mai betkar khana kha leti hai”. (Mother aged 23
years, no schooling, housewife)
“Yes, he (father) also took care of them, when he was
home during the lockdown. When I am free, I do, he takes
care of them. He does all the work like spoon-feed the
child, bathing them, etc.” (Mother aged 23 years, SSC,
housewife)
“They used to tell us how to take care of the child……I feel
good, like there is someone who gives information about
children…. yes I used to call them also.” (Mother aged 22
years, Secondary education, housewife)
“She used to ask to send photo of the food that I feed the
baby. I used to send them photos even when I was in
village.” (Mother aged 23 years, Primary education,
housewife)
• Benefits of Migration: Benefitted from open
spaces, interaction with other children, & support
from extended family
• Shared Responsibilities in the family: Male
members were home, shared child rearing
responsibility, spent time with children
• Received ration support during the pandemic
(Public Distribution System, Integrated Child
Development Services and NGOs)
• Nutrition and child health information from
health workers: Valued health messaging and
being connected during the pandemic
Group 1- Reasons for growth promoting behaviors and practices

7. • Prolonged breastfeeding: Late introduction of
complimentary feeding
• Feeding challenges: Child not eating on her own,
faulty and inadequate feeding practice
• Limited food intake: Non-expression of hunger cues,
child being cranky, only on breast milk/outside milk
• Frequent consumption of junk food: Daily intake,
consumption of Maggi/pasta replacing lunch
• Frequent episodes of illness: No fear of COVID-19,
casual hygiene practices, often sick, skin infections
etc.
Group 2: Children who remained malnourished
Reported behaviors and practices resulting in lack of improvement in children’s
nutritional status
“Almost daily, she eats biscuits, wafers, nulli,
paapad, toffee, namkeen.” (Mother aged 30
years, secondary schooling, housewife)
“She does not eat properly and she often gets
sick, how will the weight increase? I think she has
lost weight because of sickness.” (Mother aged
26 yrs, secondary schooling, housewife)
There are some children who eat food on their own
but my child does not eat on her own. She wants
me to feed her that also she takes so much of time
and it’s an everyday affair, I get tired.” (Mother
aged 29 years, graduate, housewife)

8. “kaha itna paisa hai ke roz anda, macchi, gosh khilaye.
Lockdown me kaam to hai nahi. Bus chala rahe hai jaise
taise.” (Mother aged 35 years, no schooling, housewife)
“There was no job during corona. We borrowed money
from here and there for ration.” (Mother aged 30 years, no
schooling, housewife)
I have got paralytic stroke, I worry for my child, if anything
happens to me, who will take care of him. Due to that I fall
ill sometimes. (Mother aged 28 years, Post graduate,
housewife)
“I fall ill but my son is very small and I have to do all the
work by myself.” (Mother aged 28 years, Post graduate,
housewife)
“For brother in law’s wedding, everyone had so much work
to do, so we didn’t get much time for her. baaki meri galti
hai ke maine usko time nahi diya, shadi mai kitna kaam
hota hai, hum nai us ko dyaan nahi diya, yeh mai accept
karti hun.” (Mother aged 29 years, graduate, housewife)
• Financial constraints leading to controlled
household expenses: Compromise on household
expenses, children’s needs
• Mother’s own health issues: Medication, irritation
and emotional vulnerability
• Lack of family support: Largely small nuclear
families
• Family commitments and responsibilities:
Competing priorities leading to child neglect
Group 2: Reasons for lack of improvement in children’s nutritional status

9. Policy Implications & Limitations
• Group1- Adopting healthier feeding and hygiene practices during pandemic. They also has support
from their family.
• Policy makers and civil society organizations need to make sure that good practices continue post
pandemic
• Group 2: Continued poor feeding practices and not very strict about COVID Appropriate Behaviour
• Adverse impacts, holistic approach, nutrition programming needs to address feeding challenges
faced by mothers of malnourished children and emphasis on timely complimentary feeding.
Limitations:
• Desirability bias
• Need to explore other contexts like domestic violence and its impact on child’s nutrition status