Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
7
, No
.
3,
Septem
ber
201
8
,
pp. 1
57
~
161
IS
S
N: 22
52
-
8806,
DOI: 10
.11
591/ij
phs.
v7
i
3.
1
40
66
157
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Qualit
y
o
f Ca
re
Receiv
ed
b
y C
hil
dren fr
om
1
t
o 23
M
onth
s:
Realitie
s
i
n t
he C
ity
o
f An
tanan
ar
i
vo
Fidi
niaina
Ma
my Randri
at
s
araf
ara
1
,
D
om
oina Z
af
indr
asoa R
ako
tov
ao
-
Rav
ahat
r
a
2
,
Lan
tonir
ina
Rav
aoaris
oa
3
,
Ando
Faram
ala
la
tia
na R
afanomez
an
t
soa
4
, J
e
an De
D
ie
u Marie
Rakotom
ang
a
5
,
Vahini
aris
on
Dieud
on
né
Ra
ndrian
arim
anan
a
6
1
,3,4
,
Public
He
al
t
h
Depa
rtment
of
the
Fa
cul
t
y
of
M
edi
c
ine
Ant
ana
n
ari
vo,
Mada
g
asc
ar
2
La
bora
tor
y
of
Jos
eph
Raseta
B
e
fel
a
ta
nan
a
Univ
e
rsit
y
Ho
spital A
nta
nan
ari
vo,
Ma
daga
sca
r
5,6
Nati
ona
l
Insti
t
ute
of
Public a
nd
Com
m
unity
He
al
th
,
Ant
ana
nar
i
vo,
Mada
g
asc
ar
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
J
un
30
, 2
01
8
Re
vised
Sep 5
,
201
8
Accepte
d
Se
p 12
, 201
8
Chil
dre
n
'
s
health
depe
nds
on
the
prope
r
ca
r
e
they
rec
e
ive
from
their
m
othe
rs.
Thi
s
stud
y
ai
m
s
to
desc
ribe
th
e
qual
ity
of
c
are
re
c
ei
ved
b
y
childre
n
from
1
to
23
m
onths
in
the
ci
t
y
of
An
ta
nan
ari
vo.
This
is
a
cro
ss
-
sec
ti
on
al
and
ana
l
y
t
ical
stud
y
for
a
p
eri
od
fro
m
Dec
em
ber
20
16
to
Apri
l
2017
in
the
cit
y
of
Antana
nar
ivo
w
hic
h
is
the
ca
p
ital
of
Mad
aga
sc
a
r.
Th
e
stud
y
pop
ula
ti
on
was
m
ade
up
of
420
m
othe
r
-
chi
ld
d
y
ads
l
ivi
ng
in
the
ci
t
y
of
A
nta
nan
ari
vo.
Rega
rding
th
e
c
are
recei
v
ed
b
y
chi
ldre
n
,
47.
6
%,
95%
Confide
nce
Int
erv
a
l
(C
I)
[42.
8
–
52.
4]
bene
fit
from
qual
ity
nut
rit
ion
ca
re
,
92.
3%
,
95%
CI
[89.
8
-
94.
8]
,
have
a
soci
a
l
c
are
and
4
5.
5%,
95%
CI
[40
.
9
–
50.
5]
recei
v
e
hea
l
th
c
are.
The
h
y
gie
n
e
of
l
ife
66.
4%
,
95%
CI
[61.
6
–
70.
6]
and
the
bod
y
h
y
gi
ene
35.
3%
,
95%
CI
[30.
6
–
39.
8]
improve
as
the
chi
ld
grow
s
up.
The
ca
re
rec
e
ive
d
b
y
chi
ldr
en
was
complet
e
for
the
fi
ve
t
y
p
es
in
7.
6
%,
95%
CI
[5.
1
–
10.
1]
.
W
it
h
reg
ard
to
the
pr
ofil
e
of
the
m
ot
her
,
m
othe
rs
un
der
the
age
of
1
8
(OR=3.
25,
95%
CI
[1.
07
-
9.
46
]
)
and
those
who
are
single
(OR=3.
47,
95
%
CI
[1.
24
-
9.
35]
)
offe
r
m
ore
a
cc
ep
ta
bl
e
ca
r
e
to
the
ir
infa
n
ts.
Infa
n
t
c
are
d
ep
ends
on
th
e
socio
-
ec
onom
ic
and
demographi
c
profile
of
th
e
m
othe
r.
Thus,
it
is
important
to
strengt
h
en
th
e
comm
unic
atio
n
strat
eg
y
on
i
nfa
nt
first
ai
d
g
esture
s
and
m
othe
rs'
educat
i
on
on
ch
il
d
ca
re
.
Ke
yw
or
d:
Ca
re
Hygiene
Infan
t
healt
h
Mother
Nu
t
riti
on
Copyright
©
201
8
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Ra
ndriat
saraf
a
ra F
i
din
ia
ina
Mam
y
,
Publi
c H
eal
th
Dep
a
rtm
ent o
f t
he
Fac
ulty
o
f
Me
dicine
An
ta
nan
a
riv
o,
Lot
050 F Bi
s
Am
bo
hib
a
o A
ntehir
ok
a.
A
ntanan
a
riv
o 1
05.
Mada
gascar
.
Em
a
il
:
fidyrf
m
@yah
oo.fr
1.
INTROD
U
CTION
Healt
h
is
def
i
ne
d
by
the
Wo
rl
d
Healt
h
Orga
nizat
ion
(
WH
O)
as
"a
sta
te
of
ph
ysi
cal
,
m
ental
,
so
ci
al
well
-
bei
ng
a
nd
not
just
an
abse
nce
of
dis
ease
or
in
firm
it
y"
[1
]
.
To
ge
t
cl
os
er
to
th
is
well
-
bein
g,
ever
y
ind
ivi
du
al
has
the
rig
ht
to
pri
m
ary
healt
h
care
(PHC)
,
incl
ud
i
ng
t
he
inf
an
t
[2
]
.Th
is
ca
re
include
s
vacci
nation,
acce
ss
to
dri
nk
i
ng
w
at
er
,
foo
d,
protect
ion,
hygie
ne
a
nd
acce
ss
to
basic
healt
hc
are
[3
]
.
I
n
f
act
,
an
i
m
pr
ovem
ent
i
n
the care o
f
c
hildr
e
n
m
ade
it
possible
t
o
re
duce
the
gl
ob
al
u
nde
r
-
five
m
ort
al
ity
rate
from
75
to
48
death
s
pe
r
t
hous
a
nd
li
ve
bi
rths
bet
wee
n
1990
an
d
2012
[4
]
.
In
s
ub
-
S
ah
aran
Africa
,
th
e
neonatal
m
or
ta
li
t
y
rate
rem
ai
ns
hi
gh
an
d
c
hild
r
en
bor
n
in
the
se
co
untrie
s
a
r
e
12
ti
m
es
m
or
e
li
kely
to
di
e
befo
re
thei
r
fift
h
birthday
[
5].
I
n
Ma
da
gascar
,
47
%
of
c
hildre
n
unde
r
5
s
uffer
f
ro
m
chr
on
ic
m
al
nu
trit
ion
[6
]
.
Breast
fee
ding
is
su
bo
ptim
a
l
in
14%
of
c
hildr
e
n
age
d
0
to
6
m
on
ths
and
58
%
of
child
ren
aged
6
to
24
m
on
t
hs
[
7].
And
42%
of
childre
n
un
der
5
ye
ars
old
ar
e
def
ic
ie
nt
in
Vitam
in
A
[8
]
.
The
obj
ect
ive
s
of
this
stu
dy
are
to
determ
i
ne
the
pr
e
valence
of
the
diff
e
re
nt
ty
pes
of
care
r
ece
ived
by
chi
ldre
n
unde
r
24
m
on
ths
of
ag
e
and
to
ide
ntify
the
relat
ion
s
hip
be
tween
t
he
s
ocio
-
ec
onom
ic
and
dem
og
ra
ph
ic
pro
file
of
m
ot
her
s
an
d
t
he
ca
re
recei
ved
by
thes
e
childre
n.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
3
,
Septem
ber 2
018
:
15
7
–
161
158
2.
RESEA
R
CH
METHO
D
This
was
a
cr
oss
-
sect
io
nal
an
d
analy
ti
cal
st
ud
y
f
or
a
per
i
od
fro
m
Dece
m
ber
2016
to
Fe
bruar
y
2017
in the city
o
f A
ntana
nar
i
vo
w
hich
is t
he
ca
pi
ta
l of
Mada
gas
car.
T
he
stu
dy
popula
ti
on
was
m
ade u
p o
f
m
oth
e
r
-
child
dyads
li
vi
ng
i
n
the
ci
ty
of
A
ntana
nar
i
vo.
I
nclusion
c
ri
te
ria
are
m
oth
e
rs
of
child
ren
f
ro
m
1
to
23
m
on
t
hs
of
a
ge
a
nd
who
are
care
d
for
by
their
m
oth
e
rs.
The
e
xclusi
on
crit
eria
are
t
he
el
dest
of
the
2
childre
n
unde
r
23
m
on
ths
and
on
e
of
the
twins
unde
r
23
m
on
ths.
T
he
survey
was
carried
out
a
m
on
g
the
195
F
okonta
ny
(the
sm
a
ll
est
ad
m
i
nistrati
ve
unit
in
the
co
untry
),
f
r
om
the
6
district
s
of
t
he
m
un
ic
ipali
ty
.
The
sel
ect
io
n
of
the
su
bject
s
was
by
cluster sam
pling
m
et
ho
d
.
The
s
am
ple
siz
e
was
42
0
m
oth
e
r
-
c
hild
dy
ads.
Th
e
nu
m
ber
of
pe
op
le
su
r
veyed
w
as
7
per
cl
us
te
r.
Wh
e
n
car
ryi
ng o
ut the s
urvey
the starti
ng
p
oi
nt is the cen
t
e
r
of
the fo
kont
any and
the ori
entat
ion
w
a
s don
e
by
the
te
chn
iq
ue
of
the
bott
le
.
This
te
chn
iq
ue
c
on
sist
s
in
putt
ing
the
bott
le
i
n
the
center
of
the
Fo
konta
ny,
then
tur
ning it
, and on
e
goes to
wards th
e
directi
on in
dicat
ed by t
he
hea
d
of the
b
ottl
e.
Q
ualit
y
of
ca
re w
a
s as
sesse
d
us
in
g
fi
ve
cat
egories
of
care
receive
d
by
th
e
infan
t
[9
]
,
na
m
el
y:
(i)
body
hygiene
ca
re
wh
ic
h
co
ntains
:
daily
bath,
r
e
gu
la
r
ba
ths
(e
ver
y 2
to
3
days)
,
c
hange
cl
ot
hes
at
le
ast
on
ce
a d
ay
an
d
i
ronin
g
a
fter
each w
as
h,
c
ha
ng
e
pan
ti
es
with
ea
ch
wet
or
sa
dd
l
e,
cha
ng
e
diap
ers
at
le
ast
3
tim
es
a
day
or
at
each
sad
dle,
week
ly
nail
cl
ipp
e
rs
;
(ii)
li
fe
hygien
e,
wh
ic
h
con
ta
ins
age
-
a
ppr
opriat
e
sle
ep,
m
os
qu
it
o
net
us
e,
age
-
ap
pro
pr
ia
te
toys,
play
par
tner
,
walk,
h
at
p
os
s
ession,
s
ock,
bl
ank
et
;
(iii
)
nu
t
riti
on
ca
re
w
hi
ch
co
ntains
e
xc
lusive b
reast
f
eedin
g
unti
l
6
m
on
ths
of
age
,
dieta
ry
div
e
rsificat
ion
at
6
m
on
ths
of
age,
a
de
quat
e
nu
t
riti
on
,
ade
quat
e
f
ood
hy
giene
;
(iv
)
healt
h
ca
re
wh
ic
h
co
ntain
s
correct
vacc
inati
on
(acco
r
ding
to
the
E
PI
cal
en
dar),
dewo
rm
ing
(at
le
ast
on
e
dose
of
dewo
rm
ing
received
in
over
12
m
on
ths
),
vi
tam
in
A
(o
ne
do
s
e
of
vitam
i
n
ever
y
6
m
on
ths
for
m
or
e
t
han
6
m
on
ths),
visit
syst
e
m
atic
(r
e
gula
r
visit
acco
r
ding
t
o
the
a
ge
),
m
edical
co
nsult
at
ion
(every
tim
e
the
infa
nt
fall
s
sic
k)
; a
nd
(v)
so
ci
al
care
whi
ch
c
on
ta
in
s a c
op
y
of
birth
ce
rtific
at
e an
d
re
cogniti
on of t
he
b
iol
og
ic
al
father.
Fo
r
eac
h
cat
eg
or
y,
s
pecific
cr
it
eria
wer
e
assessed.
I
f
m
or
e
than
tw
o
-
t
hirds
of
the
crit
eria
are
fu
lfil
le
d,
care
is
qu
al
ifie
d
as "
qual
it
y ca
re".
A
pre
-
te
ste
d
su
r
vey
quest
i
onnaire
a
dm
i
nistered
to
m
oth
ers
was
us
e
d
f
or
da
ta
colle
ct
ion
.
Subseque
ntly
,
the
colle
ct
ed
data
wer
e
entere
d
an
d
analy
zed
on
Epi
-
in
f
o
7so
ftwar
e
.
The
sta
ti
sti
cal
sign
ific
a
nce
t
hresh
old
use
d
was
p=
0.05.
T
he
Odds
rati
o
was
us
e
d
t
o
m
easur
e
the
ass
o
ci
at
ion
bet
we
en
t
he
dep
e
ndent
va
riable
a
nd
the
ot
her
ex
planat
ory
var
ia
bles.
For
the
lo
w
t
heor
et
ic
al
nu
m
ber
s,
the
Yates
or
F
isc
he
r
correct
ion i
s
use
d
acc
ordin
g
t
o
the
the
or
et
ic
al
v
al
ues
. T
he results a
re a
ff
e
ct
ed
by a
95%
confide
nce i
nterv
al
.
The
st
ud
y
obta
i
ned
t
he
a
gr
ee
m
ent o
f
t
he
c
hiefs of
t
he dist
rict
s an
d ea
ch
chi
ef F
ok
on
ta
ny
wh
e
re
we
ca
rr
i
ed out
our
in
vestigat
i
on.
T
he
f
ree
a
nd
i
nfor
m
ed
c
on
s
ent
of
t
he
respo
nd
e
nts
w
as
res
pected
be
fore
eac
h
inc
lusio
n.
This st
ud
y
res
pe
ct
ed
the
noti
on
of volu
nteeri
ng, a
nonym
i
ty
and co
nfi
de
ntial
it
y.
3.
RESU
LT
S
A
ND AN
ALYSIS
3.1.
C
are
Rec
ei
ved
b
y Inf
ants
In
t
otal,
the
stud
y
i
nvolv
e
d
420
m
oth
er
-
ch
il
d
pairs
.
Ta
bl
e
1
s
how
s
the
pro
portio
n
of
qual
it
y
care
receive
d
by
infa
nts.
C
oncer
ning
the
nutri
ti
on
ca
re,
only
47.6
%
,
95%
CI
[42.8
-
2.4]
of
in
fan
ts
receiv
e
acce
ptable
ca
r
e.
O
f
these
in
fan
ts,
just
ove
r
half
(55.2
0%)
of
i
nf
a
nts
unde
r
6
m
on
t
hs
of
age
ar
e
excl
usi
vely
br
east
fed,
74.28%
ben
e
fite
d
from
br
east
fee
ding
un
ti
l
24
m
on
ths
of
a
ge
,
91.
80%
of
i
nf
a
nts
old
e
r
than
6
m
on
ths
ha
d
di
et
ary
di
ve
rsity
,
40.
95%
ha
d
a
diet
a
dequat
e
am
ou
nt,
a
nd
17.
14%
hav
e
good
f
ood
hy
giene.
Infan
ts
ag
e
d 3 t
o
6 m
on
ths a
r
e the least
m
onit
or
ed
for f
ood and se
ver
e m
al
nu
t
riti
on
only
aff
ect
s t
hese i
nfants.
Table
1.
Propo
rtion o
f
T
y
pes
of C
are
Re
cei
ve
d by I
nf
a
nts
Ty
p
es
o
f
car
e
Qu
ality
of
care
9
5
% CI
n
%
Nu
trition
car
e
200
4
7
.6
4
2
.8
-
5
2
.4
So
cial ca
r
e
388
9
2
.3
8
9
.8
-
9
4
.8
Bo
d
y
hygien
e ca
r
e
148
3
5
.2
3
0
.6
-
3
9
.8
Lif
e hygien
e
279
6
6
.4
6
1
.6
-
7
0
.6
Health
care
19
1
4
5
.5
4
0
.9
-
5
0
.5
Co
m
p
lete
care f
o
r
th
e f
iv
e ty
p
es
32
7
.6
5
.1
–
1
0
.1
W
it
h
re
sp
ect
t
o
s
ocial
ca
re,
92.3%,
95
%
CI
[
89.8
-
94.8
]
,
i
nf
a
nts
ha
ve
a
cop
y
of
birt
h
c
erti
ficat
e,
of
wh
ic
h
on
ly
14.
3%
a
re
in
fa
nts
unde
r
28
days
of
a
ge.
Of
the
se
infa
nts,
76.
2%
a
re
acce
pt
ed
by
the
bi
olo
gical
father.C
oncer
ni
ng
t
he
body
hygiene
care
,
the
ol
der
the
infa
nt,
the
m
or
e
a
dequate
body
hygie
ne
c
are
is
pro
vid
e
d
(
daily
bathing,
re
gula
r
baths
,
cl
e
an
a
nd
i
rone
d
cl
oth
es,
cl
ean
diapers
or
nappies,
re
gu
l
ar
nail
cl
ipp
i
ng)
.
O
nly
35
.
3%,
95
%
CI
[30.6
-
39.8]
of
these
infa
nts
receive
d
ac
ceptable
care.
Am
on
g
these
i
nf
a
nts:
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Qualit
y o
f C
are
Recei
ved
by C
hi
ldren
fro
m 1 to 2
3 Mo
nth
s
…
(
Fidiniai
na Mamy R
andri
atsa
r
afara
)
159
20%
ha
ve
daily
bathing,
40.
9%
re
gu
la
r
ba
ths,
40%
ha
ve
cl
ean
and
ir
oned
cl
ot
hes,
83.
8%
are
re
gu
la
rly
change
d wit
h
c
le
an
na
ppie
s
or d
ia
pe
rs, an
d 1
5.2% e
njo
y
regular
nail cut.
Si
m
il
arly
,
the
m
or
e
the
child
grow
s
,
the
m
or
e
he
ta
kes
c
are
of
th
e
hygi
ene
of
the
li
fe
(appro
pr
ia
te
sle
ep
ho
ur
s
,
use
of
m
os
qu
it
o
nets,
toys
a
da
pt
ed
to
th
ei
r
a
ge
,
pa
rtne
rs
of
gam
e,
walk,
a
ccesso
ries
ada
pted
t
o
each
seas
on
a
s
hat,
s
ock
s
a
nd
blan
ket)
.
A
ccordin
g
to
t
he
hygie
ne
of
li
fe,
66.
4%,
95
%
CI
[
61.6
-
70
.6
]
of
infa
nts
rec
ei
ve
adequate
care
.
Of
these
in
f
ants,
47.
1%
ha
ve
ade
qu
at
e
sle
ep
hours,
74.
8%
sle
ep
un
der
a
m
os
qu
it
o
net,
44.8%
play
with
age
-
a
ppr
opr
ia
te
toys
and
73.8%
ha
ve
pl
ay
par
tne
rs,
77,
14%
are
ta
ken
for
walks
, a
nd 43.8%
ha
ve
acce
s
so
ries
ad
a
pted
to each
seas
on
(h
at
,
so
c
ks,
blank
et
).
Fu
rt
her
m
or
e,
healt
h
care
c
on
ce
r
ns
r
ou
ti
ne
visit
at
ion,
dewor
m
ing
,
m
edical
consulta
ti
on
a
nd
vaccinati
on.
A
ccordin
g
t
o
he
a
lt
h
care,
45.5%,
95
%
CI
[
40.
9
-
50.
5]
of
in
fan
ts
receive
d
ade
quat
e
care
.
F
or
vaccinati
on,
89.
1%
are
co
rr
e
ct
ly
vaccinate
d.
De
worm
ing
aff
ect
s
64
%
of
infa
nts
ol
der
than
12
m
on
t
hs,
but
on
ly
47.
7%
ha
ve
receiv
ed
vitam
in
A.
As
the
age
of
the
in
fa
nt
increases
,
th
ey
are
le
ss
li
kely
to
ben
efit
r
outi
ne
visit
s,
with
on
ly
25
.4%
of
infa
nts
le
ss
tha
n12
m
on
ths.
Re
gardin
g
the
m
edical
con
s
ult
at
ion
,
66.7%
of
the
infa
nts in
t
he
s
urvey
who ha
d al
read
y
fall
en i
ll
w
ere a
ble to
b
e
nef
it
fr
om
it.
3.2.
F
actors
Associ
ated wi
t
h Comple
te
C
are
Othe
rw
ise
,
T
a
ble
2
s
hows
t
hat
the
m
oth
er'
s
so
ci
o
-
ec
on
om
ic
char
act
erist
ic
s
hav
e
a
po
sit
ive
or
neg
at
ive
in
flue
nce
on the c
are
of in
fan
ts
.
Table
2.
Assoc
ia
ti
on
b
et
wee
n t
he
Mot
her’s
S
ocio
-
Eco
nom
ic
Characte
risti
cs
and the Ca
re R
ecei
ved
by t
he In
fan
t
(
N=42
0)
Moth
er’
s
so
cio
-
econ
o
m
ic
charact
e
ristics
Co
m
p
lete
care
Inco
m
p
le
te ca
re
OR
9
5
% CI
n
=3
2
%
n
=3
8
8
%
Ag
e
rang
e(
y
ears
)
1
7
and
less
6
1
8
.8
26
8
1
.3
3
.25
1
.07
-
9
.46
1
8
à
3
4
22
6
.6
310
9
3
.4
1
3
5
and
m
o
re
4
7
.1
52
9
2
.9
1
.08
0
.30
-
3
.51
Stu
d
y
level
Illiter
at
e
0
0
.0
42
1
0
0
.0
NA*
Pri
m
a
r
y
5
8
.3
67
9
1
.7
0
.75
0
.24
-
2
.19
Seco
n
d
ary
22
9
.1
220
9
0
.9
1
Un
iv
ersity
5
6
.3
59
9
3
.8
0
.85
0
.27
-
2
.50
Tr
ain
in
g
cou
rse
No
17
7
.7
191
9
2
.3
1
.29
0
.59
-
2
.80
Yes
15
6
.9
217
9
3
.1
Prof
ess
io
n
Ho
u
sewif
e
19
8
.7
189
9
1
.3
1
.54
0
.70
–
3
.4
1
W
o
rkin
g
wo
m
an
13
6
.6
199
9
3
.4
Mar
ital
statu
s
Sin
g
le
7
1
9
.4
29
8
0
.6
3
.47
1
.24
–
9
.3
5
Mar
ried
25
6
.5
359
9
3
.5
Nu
m
b
e
r
o
f
dep
en
d
en
t
ch
ild
ren
≤ 4
32
1
4
.9
266
8
5
.1
NA
>4
0
0
.0
22
1
0
0
.0
Fa
m
il
y
plan
n
in
g
No
21
9
.3
195
9
0
.7
1
.89
0
.84
-
4
.31
Yes
11
5
.9
193
9
4
.1
Daily
inco
m
e
≤2
do
llars
20
8
.8
206
9
1
.2
1
.47
0
.66
-
3
.30
>2
do
llars
12
6
.2
182
9
3
.8
Access to
wat
er
Ho
m
e
10
8
.8
104
9
1
.2
1
.24
0
.53
-
2
.50
Fo
u
n
tain
22
7
.2
284
9
2
.8
4.
DISCU
SSI
ON
S
4.1.
Pr
of
il
e
and
Pr
oporti
on o
f
C
are
Con
ce
rn
i
ng
t
he
nu
trit
io
n
car
e,
this
stud
y
f
ound
that
in
fan
t
s
receive
a
dequate
feed
i
ng
care
in
al
m
os
t
half
of
al
l
cases.
Ju
st
ov
e
r
ha
lf
of
in
fa
nts
unde
r
6
m
on
ths
of
a
ge
ha
ve
e
xclusi
ve
breast
feed
i
ng.
This
i
s
high
com
par
ed
to
th
e
2012
U
nited
Nati
ons
of
I
ntern
at
io
nal
Chil
dren'
s
Em
erg
en
cy
Fu
nd
(
U
NIC
EF)
s
urvey,
wh
ic
h
sh
owe
d
that
e
xclusi
ve
breast
feed
i
ng
a
ff
ect
s
on
ly
20%
of
al
l
infan
ts
unde
r
6
m
on
ths
i
n
Ce
ntral
an
d
West
Africa
[
10]
.
R
egardin
g
s
ocia
l
care,
92.
39
%
of
in
fan
ts
ha
ve
a
co
py,
w
hic
h
is
sim
il
ar
to
Dem
og
ra
ph
ic
healt
h
su
r
vey
DHS IV, w
hich
sta
te
s
that 80%
of c
hi
ldren un
der
5 y
ears of
a
ge
a
r
e re
gistered
[1
1].
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
3
,
Septem
ber 2
018
:
15
7
–
161
160
In
ad
diti
on,
he
al
thy
li
festy
le
and
bo
dy
hy
gi
ene
ca
re
inc
re
ases
with
the
a
ge
of
the
c
hild
I
nd
ee
d,
the
m
or
e
the
bab
y
grows,
t
he
m
ore
the
m
oth
er
gi
ves
him
at
t
ent
ion
,
wh
ic
h
c
ould
e
xp
la
in
this
sit
uation.
Re
gardin
g
healt
h
ca
re,
le
ss
tha
n
hal
f
of
in
fan
ts
a
re
c
on
ce
r
ned.
I
nde
ed,
t
he
r
outi
ne
visit
co
ncern
s
only
one
thi
rd
of
infa
nts.
A
nd
e
ven,
this
rate
de
creases
as
the
infan
t
increa
s
es
in
age.
Acc
ordin
g
to
al
l
the
m
oth
ers,
the
y
do
not
know
that
the
infan
t
nee
ds
routine
visit
s
after
the
la
st
vaccine.
Sim
ilarly
,
m
oth
ers
of
te
n
unde
rest
i
m
at
e
dewo
rm
ing
,
ye
t
the
W
orl
d
Healt
h
O
rg
a
nizat
ion
(
WHO)
say
s
that
increase
d
co
ve
rag
e
of
de
w
or
m
ing
sign
ific
a
ntly
dec
reases t
he pr
oport
ion o
f
helm
inthiase
s in
c
hildr
e
n [12].
Nev
e
rtheless
, m
oth
ers
do
not
under
e
stim
at
e
m
edical
con
s
ultat
ion
s.
I
ndeed
,
sic
k
child
re
n
are
ta
ke
n
to
m
edical
con
sul
ta
ti
on
in
m
or
e
than
half
of
the
cases.
Other
m
oth
ers
w
ho
do
not
ta
ke
childre
n
to
m
edical
consulta
ti
on
ha
ve
p
racti
ce
ei
ther
sel
f
-
m
edicat
ion
or
t
rad
it
ion
al
m
edici
ne.
The
old
e
r
t
he
infa
nts,
the
m
or
e
they
are
no
lo
nger
bro
ught
to
a
m
edical
con
s
ul
ta
ti
on
.
The
ec
onom
ic
pr
oble
m
is
on
e
of
th
e
com
m
on
ob
s
ta
cl
es
pr
e
ve
nting m
ot
her
s
fro
m
takin
g
thei
r
c
hildr
e
n t
o
m
edical
co
nsu
lt
at
ion
.
Re
gardin
g
vac
ci
nation,
the
re
has
al
s
o
been
a
m
ark
ed
im
pr
ovem
ent.
In
f
act
,
89.
04%
of
infa
nts
are
correct
ly
vaccinate
d.
O
n
th
e
oth
er
hand,
DS
H
IV
s
hows
that
55%
of
in
fan
ts
a
re
cor
rectl
y
vac
ci
nate
d
accor
ding
t
o
t
he
E
PI
sche
du
le
[11].
E
xactl
y,
effo
rts
ha
ve
bee
n
m
ade
by
the
go
vernm
ent
an
d
U
NI
C
EF
t
o
i
m
pr
ove
the
va
cci
nation
c
overag
e
rate
(
pur
chase
of
vacci
nes,
rei
nfor
ce
m
ent
of
the
co
ld
chain,
tra
nsport
of
vaccines
,
id
ent
ific
at
ion
of
are
as
of
l
ow
c
ov
e
rag
e
).
U
nfo
rtu
natel
y,
the
un
va
cci
nated
10.
9%
sti
ll
pose
a
r
isk
of
disease
dev
el
opm
ent.
4.2
.
Associ
at
ion
between
t
he
Mother's
S
ocio
-
Ec
onomi
c
Ch
ar
ac
terist
ic
s
a
nd
th
e
C
are
Recei
ved
by
the
Infant
Re
gardin
g
the
relat
ion
sh
i
p
be
tween
the
ag
e
of
the
m
oth
er
and
the
car
e
received
by
the
infan
t,
m
oth
ers
ov
e
r
t
he
age
of
35
a
re
the
le
ast
li
kely
to
pr
ovi
de
acce
ptable
car
e
for
their
c
hildr
e
n.
Indee
d,
m
oth
ers
are
el
der
ly
and
do
not
hav
e
e
nough
ti
m
e,
ph
ysi
cal
streng
th,
or
thin
k
they
hav
e
e
nough
e
xp
e
rience
in
th
e
care
of
t
he
in
fa
nt.
Si
m
il
arly
,
the
m
ajo
rity
of
th
e
m
do
not
do
so
m
e
trai
nin
g
about
in
fa
nt
care.
You
ng
e
r
m
oth
ers
(un
der
age
18)
are
the
best
t
o
care
their
ch
il
dr
en
.
These
young
m
oth
ers
feel
le
ss
co
m
petent
an
d
fo
ll
ow
the
adv
ic
e
of
healt
h
pro
fessio
nals
.
Othe
r
stud
ie
s
hav
e
al
s
o
sho
wn
the
c
on
t
rib
ution
of
yo
ung
m
oth
ers
in
car
ing
f
or
her chil
dren
[1
3,14
]
.
Fo
r
t
he
relat
io
ns
hi
p
bet
ween
the
m
oth
er'
s
le
vel
of
e
ducat
ion
a
nd
the
ca
re
receive
d
by
the
infa
nt,
none
of
the
il
li
te
rate
m
oth
ers
pro
vid
e
ade
qu
at
e
care
for
the
ir
childre
n.
In
fact,
these
il
li
t
e
rate
m
oth
ers
do
no
t
unde
rstan
d
.
T
he
inform
ation
s
giv
en
by
heal
th
work
e
rs.
Si
m
il
arly
,
they
do
not
ta
ke
their
childre
n
to
he
al
th
center
[
15
]
.
W
it
h
re
gard
t
o
th
e
relat
ionshi
p
betwee
n
t
he
tr
ai
nin
g
c
ourse
r
ecei
ved
by
t
he
m
oth
er
an
d
t
he
care
the
infa
nt
recei
ves,
m
oth
ers
w
ho
h
a
ve
no
t re
cei
ved
tr
ai
ning
are
m
or
e
li
kely
to
pro
vid
e
ac
ceptable
ca
re
to
thei
r
childre
n.
I
nd
e
ed,
t
he
m
oth
ers,
hav
i
ng
rec
ei
ved
trai
ning,
do
not
ch
an
ge
their
hab
it
s.
On
the
oth
e
r
ha
nd,
m
oth
ers
w
ho
ha
ve
no
t
receiv
ed
a
ny
trai
ni
ng
get
m
or
e
in
for
m
at
ion
from
their
ent
ourag
e
(
gr
a
ndm
o
ther,
a
un
t
).
Accor
ding
to
m
arit
al
sta
tus,
sing
le
m
oth
ers
are
m
or
e
li
kely
to
pro
vid
e
ac
ceptable
ca
re
to
their
child
re
n.
T
hi
s
sit
uation
c
ould
b
e
due to
the
fa
ct
that these
m
oth
ers
are
he
lped by
oth
e
r m
e
m
ber
s of the
f
am
ily.
The
nu
m
ber
of
hous
e
wives
pro
vid
i
ng
a
de
quat
e
care
f
or
th
ei
r
infa
nts
is
sli
gh
tl
y
higher
t
han
t
hat
of
work
i
ng
m
oth
ers.
I
n
fact,
sta
y
-
at
-
hom
e
mo
the
rs
ha
ve
m
uch
m
or
e
tim
e
to
sp
en
d
with
their
infan
ts,
un
li
ke
work
i
ng
m
oth
ers
who
oft
en
s
pend
their tim
e
w
orkin
g
to i
m
pro
ve
the f
am
i
l
y'
s
inco
m
e. Si
m
il
a
rly
,
the li
t
eratu
r
e
sh
ows
t
hat
m
ot
her
s'
m
a
te
rn
it
y
le
ave
has
a
po
sit
ive
influ
e
nc
e
on
t
he
healt
h
of
i
nf
a
nts
[
16]
.
For
m
oth
ers
with
a
daily
incom
e
of
m
or
e
than
$
USD
2,
they
c
are
le
ss
f
or
the
ir
infa
nts.
Inde
ed,
it
is
the
na
nn
ie
s
w
ho
ta
ke
care
of
their c
hildr
e
n.
Accor
ding
to
t
he
res
ults,
al
l
m
oth
ers
with
m
or
e
than
4
de
pende
nt
child
ren
do
not
pr
ovide
qu
al
it
y
care
to
their
in
fan
ts.
I
ndee
d,
these
m
oth
ers
are
ei
ther
too
busy
with
seve
r
al
children
to
r
ai
se,
or
they
le
t
the
el
der
s
of
her
c
hildr
e
n
ta
ke
ca
re
of
oth
e
r
sibl
ing
s
.
This
ca
re
is
no
t
total
ly
adequate
.
Nev
e
r
thele
ss,
acco
r
di
ng
to
the
li
te
ratur
e
,
sibli
ngs
a
re
sti
ll
necessary
beca
us
e
si
bling
s
play
a
n
i
m
po
rtant
r
ole
in
the
psy
ch
om
oto
r
dev
el
op
m
ent of in
fan
ts
[17
]
.
Fo
r
fam
il
y
plann
i
ng,
pr
act
ic
i
ng
m
oth
ers
a
re
usual
ly
el
der
l
y
wo
m
en
who
wan
t
t
o
li
m
i
t
the
nu
m
ber
of
childre
n.
T
hus
,
their
child
re
n
do
not
receive
ade
quat
e
care.
Re
ga
rd
i
ng
the
relat
ion
s
hi
p
betwee
n
ac
cess
to
water
an
d
the
care
receive
d
by
the
infa
nt,
m
oth
ers
with
a
ccess
to
water
at
ho
m
e
hav
e
m
or
e
acce
ptab
le
ca
re.
Of
c
ourse,
t
he
qu
al
it
y
of
pe
rsonal
hy
giene
,
foo
d
hy
gien
e
and
li
festy
le
dep
e
nd
of
th
e
acce
ss
to
w
at
er.
Accor
ding
to
the
res
ults
of
this
stu
dy,
al
l
the
el
em
ents
c
on
sti
tuti
ng
the
prof
il
e
of
the
m
oth
er
ha
ve
a
gr
ea
t
i
m
pact o
n
t
he
c
are r
ecei
ve
d by the in
fa
nt
.
At
the
en
d
of
this
stud
y,
sug
gestio
ns
are
propose
d
f
or
the
i
m
pr
ovem
ent
of
t
his
care
prov
i
ded
t
o
infa
nts.
T
hey
f
ocus
on
stre
ngthening
t
he
c
om
m
un
ic
at
ion
s
trat
egy
on
i
nf
a
nt
fir
st
ai
d
ges
tures
a
nd
e
duc
at
ing
m
oth
ers
on
ch
il
dcar
e.
E
nfo
rc
e
m
ent
of
t
he
r
igh
ts
of
w
om
e
n
wit
h
inf
ants
unde
r
24
m
on
ths
of
age
a
nd
th
e
delivery
of
bir
th
cop
ie
s
are
a
lso
require
d.
F
inall
y,
healt
h
centers
al
so
nee
d
to
i
m
pr
ove
serv
ic
e
pro
visio
n
for
the care
of i
nf
a
nts.
Fi
nally
, we sug
gest ex
te
ndin
g
this
ty
pe of
stu
dy n
at
io
na
ll
y fo
r
Ma
da
ga
scar
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Qualit
y o
f C
are
Recei
ved
by C
hi
ldren
fro
m 1 to 2
3 Mo
nth
s
…
(
Fidiniai
na Mamy R
andri
atsa
r
afara
)
161
5.
CONCL
US
I
O
N
This
stu
dy
ha
s
show
n
t
ha
t
the
m
oth
er's
so
ci
o
-
ec
onom
ic
and
dem
ogra
ph
ic
prof
i
le
has
a
consi
der
a
ble in
flue
nce
on
t
he diffe
re
nt care r
ecei
ved
by the
infa
nt.
O
ur r
e
s
ults ha
ve
thei
r l
i
m
it
s f
ro
m
the point
of
view
of
representat
ive
ness
.
H
oweve
r,
t
he
y
inform
us
ab
ou
t
t
he
m
oth
er
'
s
beh
avi
or
re
ga
rd
i
ng
t
he
ca
re
sh
e
offer
s
to
her
c
hild
acco
rd
i
ng
to
her
s
ocio
-
ec
onom
ic
pr
of
il
e.
Thus,
the
go
ve
rn
m
ent
and
th
e
Mi
nistry
of
Healt
h
sh
oul
d
desi
gn
a
new
ta
rget
ed
pro
gr
am
to
prom
ote
m
oth
er’s
trai
ning
a
nd
raise
the
sta
nd
ard
of
li
ving
of
th
e
popula
ti
on
i
n o
rd
e
r
to
achie
ve
the c
urren
t
go
al
: "Heal
th for
m
oth
er and
c
hild".
REFERE
NCE
S
[1]
Prea
m
ble
to
th
e
Constit
ut
ion
of
the
W
orld
He
a
lt
h
Organ
iz
a
ti
on
,
as
adopted
b
y
the
Int
ern
ation
al
Conf
ere
n
ce
o
n
Hea
lt
h
,
New
York,
19
June
-
22
J
ul
y
1946
;
signe
d
on
22
Jul
y
19
46
b
y
the
r
epr
es
ent
a
ti
ves
of
61
Stat
es.
(Off
ic
i
a
l
Rec
ords of
the
W
orld
Hea
lt
h
Or
gani
z
at
ion
,
No.
2,
p
.
100)
an
d
en
t
ere
d
int
o
forc
e
o
n
April
7
,
1948
.
[2]
W
orld
Hea
lt
h
Or
gani
z
at
ion
.
W
orl
d
Hea
lt
h
Repor
t. Prim
ar
y
Hea
l
th Care
-
Now
m
ore
t
han
ev
er
.
W
HO
,
Gene
va
,
ISBN
978
92
4
256373
3
ISS
N 1020
-
332X
,
2008.
[3]
Report
of
the
Econom
ic
,
Soci
al
a
nd
Envi
ronm
ental
Counc
il
in
M
oroc
co.
Basic
he
al
th
ca
r
e:
Towa
r
ds
equi
ta
b
le
and
w
ide
sprea
d
acc
ess.
Refe
ren
c
e
4/2013:
111p.
ISBN
:
978
-
9954
-
9389
-
3
-
5
ISS
N
:
2335
-
9242,
Avail
ab
le
from
:
ww
w.c
ese
.
m
a, 2
018.
[4]
W
orld
Hea
lt
h
Organi
z
at
ion
.
Glo
bal
he
alth
sta
ti
st
ic
s
2014.
W
HO
,
Gene
va
,
2014
:
178p.
ISBN
978
92
4
069268
8
,
2014.
[5]
Unite
d
Nat
ions o
f
Inte
rn
at
ion
al
Chil
dre
n
'
s E
m
er
gency
Fund.
70
y
e
ars
for
e
ac
h
ch
il
d.
The
si
tua
t
ion
of
chi
ld
ren
in
th
e
world
in
2016:
equa
l
oppor
tuni
t
ie
s
for
ev
er
y
child.
UN
ICEF,
Ne
w
York,
ISBN
:
978
-
92
-
806
-
4839
-
3.
[c
it
ed
201
8
Feb
6]
.
Availabl
e
from
:
ww
w.uni
ce
f
.
data.
org
,
2
016.
[6]
Unite
d
Nati
ons
of
Inte
rna
t
iona
l
Chil
dre
n
'
s
Emerge
nc
y
Fund
.
Abs
tra
ct
of
the
Inve
st
m
ent
Plan
for
Nutrit
ion
i
n
Mada
gasc
ar
.
UN
ICEF,
15
p
,
201
7.
[7]
Nati
ona
l
Monito
ring
Surve
y
o
f
th
e
Mil
le
nnium D
eve
lopment
Goa
ls i
n
Mad
aga
sc
ar
,
2012
-
2013
.
[8]
Global
pre
v
alen
ce
of
v
it
amin
a
def
iciency
in
po
pula
ti
ons
at
r
isk
1995
–
2005.
W
HO
Global
Database
on
Vit
amin
a
Defi
cienc
y
,
200
9.
[9]
UN
ICEF,
W
HO,
UN
ESCO,
U
NF
PA
,
UN
D
P,
UN
AID
S,
W
FP
,
W
ORLD
BANK.
Fac
ts
for
life.
4th
edition
.
UN
ICEF,
New
York Apr
2010: 194p.
ISBN
:
978
-
92
-
806
-
4466
-
1
[10]
Sokol
E,
Agua
yo
VM
,
Cla
rk
D.
,
“
Protec
t
bre
astf
ee
ding
in
W
est
and
Cent
ra
l
Afri
ca
.
25
y
e
ars
of
a
ppli
c
at
ion
of
the
Inte
rna
ti
ona
l
Co
de
on
the
Mark
et
ing
of
Bre
ast
m
il
k
Subs
ti
tut
es
”
Daka
r
:
Uni
cef
-
Regi
onal
Of
fic
e
for
W
est
a
nd
Cent
ra
l
Afri
ca
;
2
007.
44
p.
[cited
2018
Jan
8]
.
Av
ai
l
abl
e
from
:
htt
p://ww
w.uni
c
ef.
org/wc
aro
/W
CAR
_Protege
r_a
llaitem
ent
_m
ate
rne
l_
Cod
e_c
o
m
m
erc
ia
li
sat
ion
_Fr.pdf.
[11]
Instit
ut
Nati
on
al
de
la
Stat
ist
i
qu
e
(INS
TAT)
and
ICF
Mac
ro,
“
Dem
ogra
phic
an
d
Hea
lt
h
Surve
y
of
Mada
gasc
ar
2008
-
2009”,
Ant
ana
nar
ivo, Madagasca
r:
INS
TAT
and
ICF
Mac
ro
,
2010.
[12]
W
orld
Hea
lt
h
O
rga
nizati
on
,
“
Conti
nuing
Ac
ti
on
To
Reduce
Th
e
Global
Im
pact
Of
Negle
c
te
d
Tr
opic
a
l
Disea
ses:
Second
W
HO
Report
On N
egl
e
c
te
d
Tropi
c
al Disea
se
”,
W
HO
,
Ge
neva
:
138p
ISB
N 978
92
4
2564
54
9
,
2014.
[13]
Luste
r,
T
.
,
&
Br
oph
y
-
Herb
,
H.
,
“
Adolesc
ent
Mo
the
rs
and
Their
C
hil
dre
n
.
In
D.
Os
ofsky
&
H.
E.
Fitz
ger
al
d
(Eds.
)
”
WAI
MH
Handbook
ofi
nfan
t
me
ntal
health
,
Vol
":
Infa
nt
m
ent
a
l
hea
l
th
in
group
s
at
high
risk.
New
York:
W
il
e
y
,
2000.
[14]
Jahrom
i,
L.
B.
,
Putnam,
S.
P.,
&
Stift
er
,
C.
A.
,
“
Mate
rna
l
Reg
ula
ti
on
of
Infa
n
t
Rea
ctivity
from
2
to
6
Months,
”
Dev
el
opmen
tal
Psyc
holog
y
,
40:
477
-
487,
2004
.
[15]
Adam
W
agsta
ff,
“
Poverty
and
in
equa
l
it
i
es
in
the
hea
l
th
sec
tor,”
B
ull
etin
of
the
World
Healt
h
Or
ga
nizati
on
,
80(2):
97
–
105
,
2002
.
[16]
Fios
si
Kpadonou
É,
Odjo
A,
Djidonou
A,
K
padonou
TG.
,
“
Bab
y
'
s
int
en
ti
on
al
sm
il
e
and
m
at
ern
al
associa
t
e
d
fac
tors,
”
N
europsyc
hiat
ri
e
de
l’
E
nfanc
e
et de l’
Ad
ole
sce
n
ce
,
65(5)
:281
–
8
,
2017
.
[17]
Nina
How
e,
Holl
y
Recchi
a.
,
“
Frate
rn
al
re
lation
s
and
the
ir
i
m
p
ac
t
on
chi
ldr
en
's
deve
lopment,”
Pe
er
relations
,
CEDJE/
RS
C
-
DJE
.
Ed
rev
Ja
n
2015:
1
-
9.
[ci
te
d
2018
Jun
6
]
.
Av
ai
l
abl
e
from
:
htt
p://ww
w.e
nfa
nt
-
ency
c
lope
di
e.co
m
/sit
es/de
fau
lt
/f
i
le
s/te
x
te
s
-
exp
erts
/fr/
101/l
es
-
r
el
a
t
ions
-
fra
te
rn
el
l
es
-
et
-
l
eur
-
impac
t
-
sur
-
le
-
deve
lopp
ement
-
des
-
enf
ant
s.pd
f,
2015.
Evaluation Warning : The document was created with Spire.PDF for Python.