Psychosocial Predictors of Infant and Young Child Feeding Practices Among Mother-Child Dyads in Malawi and South Africa.

Maternal capacity to adhere to recommended infant and young child feeding (IYCF) practices may be influenced by psychosocial factors. However, research examining associations between psychosocial factors and IYCF practices, and in particular complementary feeding indicators, is limited. As part of the Khula birth cohort study, we aimed to investigate associations between maternal depression, exposure to intimate partner violence (IPV), social support and stimulating home environments with IYCF practices among mother-child dyads in Malawi (n = 153) and South Africa (n = 255). When children were 10-16 months of age, mothers completed a series of psychosocial and child diet questionnaires. Regression modelling assessed associations between maternal psychosocial measures and IYCF indicators, adjusting for maternal age, education, marital status and household socioeconomic status. IYCF practices were suboptimal in both settings, with 50%-54% meeting the minimum dietary diversity (MDD), 67%-73% the minimum meal frequency (MMF) and 39%-45% the minimum acceptable diet (MAD) indicators. In South Africa, mothers exposed to IPV in the previous 12 months were less likely to meet the MDD and MAD recommendations (MDD: OR 0.38, 95% CI: 0.19, 0.75; p = 0.006; MAD: OR 0.41, 95% CI: 0.20, 0.85; p = 0.02). There was a significant positive association between stimulation (i.e., more books/toys/play activities) and dietary diversity scores in South Africa. In adjusted analyses, maternal depression and social support were not significantly associated with IYCF indicators in either setting. IYCF programmes may benefit from supporting maternal psychosocial wellbeing and integrating nurturing care to improve children's dietary intakes, growth and development.