Grandmothers' knowledge positively influences maternal knowledge and infant and young child feeding practices.

OBJECTIVE

To examine associations between grandmothers' knowledge and infant and young child feeding (IYCF) practices and to test whether the associations are independent of or operate via maternal knowledge.

DESIGN

Cross-sectional household survey data from households with a child under 5 years (n 4080). We used multivariate regression analyses, adjusted for child, maternal, grandmother and household characteristics, and district-level clustering, to test associations between grandmothers' knowledge and IYCF practices for children aged 6-24 months living with a grandmother. We used causal mediation to formally test the direct effect of grandmothers' knowledge on IYCF practices v. maternal knowledge mediating these associations.

SETTING

Two hundred and forty rural communities, sixteen districts of Nepal.

SUBJECTS

Children aged 6-24 months (n1399), including those living with grandmothers (n 748).

RESULTS

We found that the odds of optimal breast-feeding practices were higher (early breast-feeding initiation: 2·2 times, P=0·002; colostrum feeding: 4·2 times, P<0·001) in households where grandmothers had correct knowledge v. those with incorrect knowledge. The same pattern was found for correct timing of introduction of water (2·6), milk (2·4), semi-solids (3·2), solids (2·9), eggs (2·6) and meat (2·5 times; all P<0·001). For the two pathways we were able to test, mothers' correct knowledge mediated these associations between grandmothers' knowledge and IYCF practices: colostrum feeding (b=10·91, P<0·001) and the introduction of complementary foods (b=5·18, P<0·001).

CONCLUSIONS

Grandmothers' correct knowledge translated into mothers' correct knowledge and, therefore, optimal IYCF practices. Given grandmothers' influence in childcare, engagement of grandmothers in health and nutrition interventions could improve mothers' knowledge and facilitate better child feeding.