Using Cultural Domain Analysis to Understand Community Perceptions of Infant and Young Child Foods in Sri Lanka

1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children Design: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data followed an inductive approach whereby themes were identified, coded, and extracted for interpretation using Dedoose. Findings across methods were triangulated to enhance credibility. 1. Among all sectors of Sri Lanka, caregivers identified rice as the most important food for young children diets, highlighting the importance of this staple regardless of sector or ethnicity. Only 2 animal source foods (eggs and fish) were included within the top 15 most salient foods. 2. Local food classification systems highlight a ‘hot’ and ‘cold’ paradigm, reflecting the underlying Ayurvedic medical belief system, influencing dietary choices. 3. Overall, 48 food proscriptions were identified, including ‘egg’ and ‘fish, specifically during child illness. Some locally-available fruits and vegetables were also proscribed, depending on their ‘cold’ nature, level of digestibility, and relation to illness causation. Prescribed foods (n = 47) were also found, most of which were herbal remedies (22 food or spice mixtures) to address child illness. Understanding local food definitions, food classification systems, and food rules may aid in shaping policies aiming to include culturally-appropriate strategies to improve feeding practices in Sri Lanka. UNICEF.