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To assess the influence of a mobile produce market (MPM) on fruit and vegetable access.
Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM.
Low-income neighbourhoods with limited access to fruits and vegetables.
Older (≥60 years) and younger (18–59·9 years) shoppers.
Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %).
MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.
To better understand the enabling and challenging factors impacting on infant feeding practices in communities with a high HIV prevalence.
Qualitative study, with data collected through in-depth interviews and observations of mothers, in addition to discussions with health-service providers.
Urban settlement in the province of KwaZulu-Natal, South Africa.
Mothers recruited from an HIV clinic and from within the community.
Emerging from discussions with mothers on the acceptability of alternative feeding methods were the challenges they encountered in feeding their infants. Mothers readily identified feeding in the context of HIV infection as an issue of great concern, encompassing three central themes: (i) stigma and disclosure of HIV; (ii) confusion and coercion; and (iii) diarrhoea, sickness and free formula. It became evident that mothers rarely received quality infant feeding counselling and consequently mixed feeding, a widespread practice but one that is highly risky for HIV transmission, remained a common feeding practice. Exclusive breast-feeding (EBF) was best practised with support, following disclosure of HIV status. Availability of free formula did not guarantee exclusive formula feeding but instead led to inappropriate feeding practices.
In addition to providing accurate information, health-care workers must be empowered to counsel mothers effectively, addressing issues of disclosure and thereby facilitating mobilization of maternal support networks. These findings illustrate the challenges that exist in policy translation within the context of quality of training for health-care workers on optimizing maternal infant feeding practices, particularly in HIV-prevalent, resource-poor settings.
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