CHILD FEEDING AND CARE BEHAVIORS ARE ASSOCIATED WITH XEROPHTHALMIA INRURAL NEPALESE HOUSEHOLDS

The study examined caregiver-child interactions, intrahousehold food a llocation and general child care behaviors and their effect on childre n's xerophthalmia status in the rural Terai region of Nepal. Seventy-e ight households with a child having a history of xerophthalmia (cases) were matched with 78 households with a child of the same age having n o history of xerophthalmia (controls). Seven day-long continuous monit oring observations were performed in each household (over 15 months) b y trained Nepali observers, focusing on feeding and care of a focus ch ild and his/her younger sibling. Nineteen different behavioral variabl es were operationalized, including serving method, second helpings, se rving refusals, encouragement to eat, request intensity, meal serving order, Food channeling, food sharing, positive social behaviors, negat ive social behaviors, and positive health behaviors. Automatic serving and request intensity were strongly negatively correlated, especially among younger siblings. Children who serve themselves receive less en couragement to eat. Those children who are refused in their requests f or food tend to ask for food more frequently, for a longer time, and b e less likely to self-serve. Children who eat from a shared plate are less likely to interact with a food server and more likely to self-ser ve. Negative social behavior towards children is associated with the c hild having to request food more frequently and a greater likelihood o f being refused food. Children who receive positive health care from t heir caregivers are also more frequently asked if they would like food by the server and are encouraged to eat. Several caregiver-child Feed ing behaviors were related to a child's risk of having past vitamin A deficiency. Controls were much more likely to be served food automatic ally. Cases were more likely to serve themselves food and have multipl e servings of food. Cases were nearly two times more likely than contr ols to be treated with neglect or harshly, and much less likely than c ontrols to have their health needs receive attention. Examining intrah ousehold behavior is critical for understanding the causes of vitamin A deficiency in rural Nepalese children, and has great potential for i dentifying and improving interventions to improve children's diets and care. (C) 1998 Elsevier Science Ltd. All rights reserved.