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Gonete KA, Angaw DA, Gezie LD. Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis. BMC Pediatr 2024; 24:151. [PMID: 38424574 PMCID: PMC10903031 DOI: 10.1186/s12887-024-04635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality. METHODS From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed. RESULTS The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD. CONCLUSION The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers.
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Affiliation(s)
- Kedir Abdela Gonete
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Rahman MA, Kundu S, Rashid HO, Tohan MM, Islam MA. Socio-economic inequalities in and factors associated with minimum dietary diversity among children aged 6-23 months in South Asia: a decomposition analysis. BMJ Open 2023; 13:e072775. [PMID: 38128933 DOI: 10.1136/bmjopen-2023-072775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE This study aimed to determine the factors associated with minimum dietary diversity (MDD) and estimate the socioeconomic inequalities in MDD among children from five South Asian countries. DESIGN Cross-sectional. SETTING The study used the most recent round of secondary databases of Demographic Health Survey data of Bangladesh (2017-2018), India (2019-2021), Maldives (2016-2017), Nepal (2018) and Pakistan (2017-2018). PARTICIPANTS This study used information on MDD and other explanatory variables from a total of 136 980 (weighted) children aged 6-23 months. METHODS Multivariable logistic regression was employed to identify the factors associated with MDD and concentration index (CIX) and Lorenz curve were used to measure the socioeconomic inequalities in MDD. RESULTS The overall weighted prevalence of MDD in South Asia was 23.37%. The highest prevalence of MDD was found among children from Maldives (70.7%), while the lowest was in Pakistan (14.2%). Living in affluent versus poor households, having a mother who is employed versus a mother who is unemployed, exposure to various forms of media (newspapers and magazines), seeking antenatal care (ANC) more than four times compared with those who sought ANC less than four times and having children older than 4 years old are the most common significant factors associated with MDD deficiency. This study found the value of the CIX for MDD (MDD: CI=0.0352; p<0.001) among children with a higher socioeconomic status, suggesting inequality in MDD in favour of the more among well-off households. CONCLUSION Inequality in the prevalence of MDD favours the affluent. Health policy and intervention design should prioritise minimising socioeconomic inequalities concerning the MDD. In addition, policy-makers should prioritise the associated factors of MDD such as education, wealth status, employment, media exposure while designing intervention or policies.
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Affiliation(s)
| | - Satyajit Kundu
- Biochemistry and Food Analysis, Patuakhali Science and Technology University, Patuakhali, Bangladesh
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Engidaw MT, Gebremariam AD, Kefale B, Tesfa D, Tiruneh SA, Shiferaw YF. Impact of the Productive SafetyNet Program on the minimum acceptable diet in the rural community of South Gondar Zone, Northwest Ethiopia. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2022.977727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BackgroundEven though numerous factors contribute to undernutrition, it can happen immediately due to poor intake and illness. A minimum acceptable diet is one of the proxy measures for adequate consumption, which is an impact indicator for the Productive SafetyNet Program (PSNP). As a result, this study aimed to assess the impact of PSNP on the minimum acceptable diet among rural infants in the South Gondar Zone, Northwest Ethiopia.MethodsA community-based cross-sectional study design was employed in the selected woredas (districts) of South Gondar Zone, Northwest Ethiopia, from 1 December 2017 to 30 January 2017. A total of 442 participants' data were collected during this time period through interviews with their mothers or caregivers. A multistage sampling technique was employed to select study subjects and interviewees using a structured questionnaire. Stata version 16 (MP) was employed to carry out a statistical analysis. A binary logistic regression model was employed to identify significant variables. The statistical significance was declared at a p-value of more than 0.05.ResultsThe highest proportion of adequate diet diversity scores (261 [59.05%]) was from households who graduated (not part of it) from PSNPs. In this study, the magnitude of adequate dietary diversity, meal frequency, and minimum acceptable diet was 79.86, 82.58, and 66.52%, respectively. Marital status (AOR = 3.98, 95% CI: 1.39, 11.40), child age (AOR = 2.82, 95% CI: 1.78, 4.47), the educational status of the father (AOR = 0.56, 95% CI: 0.35, 0.89), the wealth index (AOR = 0.27, 95% CI: 0.12, 0.64), and the place of delivery (AOR = 3.14, 95% CI: 1.47, 6.73) were significant predictors for minimum acceptable diet uptake by children.ConclusionIn this study, two-thirds of the infants had/received a minimum acceptable diet. Furthermore, infants from households with Productive SafetyNet users had a low minimum acceptable diet. Marital status, the educational status of the father, child age, the wealth index, and the place of delivery were associated factors with having an adequate intake of minimum acceptable diet by the children. Therefore, efforts to address sociodemographic and child-related factors during routine care are crucial.
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Dou N, Shakya E, Ngoutane RM, Garnier D, Kouame OR, Dain AL, Garg A, Kodish SR, Caulfield LE, Murray‐Kolb LE, Na M. Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016. MATERNAL & CHILD NUTRITION 2023; 19:e13418. [PMID: 36069310 PMCID: PMC9749586 DOI: 10.1111/mcn.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Abstract
Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.
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Affiliation(s)
- Nan Dou
- Department of Nutritional Sciences, College of Health and Human DevelopmentThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Evaniya Shakya
- Department of Nutritional Sciences, College of Health and Human DevelopmentThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Raphia M. Ngoutane
- Department of Nutritional Sciences, College of Health and Human DevelopmentThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | | | - Oka R. Kouame
- National Nutrition Programme, Ministry of Health and Public HygieneAbidjanCôte d'Ivoire
| | | | | | | | - Laura E. Caulfield
- Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Laura E. Murray‐Kolb
- Department of Nutrition Science, College of Health and Human SciencesPurdue UniversityWest LafayetteIndianaUSA
| | - Muzi Na
- Department of Nutritional Sciences, College of Health and Human DevelopmentThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
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Nurokhmah S, Middleton L, Hendarto A. Prevalence and Predictors of Complementary Feeding Practices Among Children Aged 6-23 Months in Indonesia. J Prev Med Public Health 2022; 55:549-558. [PMID: 36475320 DOI: 10.3961/jpmph.22.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). METHODS We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children's Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design. RESULTS The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali. CONCLUSIONS It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low.
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Affiliation(s)
- Siti Nurokhmah
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Nutrition Science, Faculty of Health Science, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
| | - Lucinda Middleton
- Research Institute for the Environment and Livelihoods, Charles Darwin University, Ellengowan Drive, Australia
| | - Aryono Hendarto
- Department of Child Health, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Jalata DD, Asefa BG. Trends and Determinants of Dietary Diversity in Children Aged 6-59 Months in Ethiopia: Analysis of 2005-2016 Demographic and Health Survey. Curr Dev Nutr 2022; 6:nzac135. [PMID: 36475020 PMCID: PMC9718648 DOI: 10.1093/cdn/nzac135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/23/2022] [Accepted: 08/25/2022] [Indexed: 04/22/2024] Open
Abstract
Background Dietary diversity may be associated with health and optimum growth in children. Objectives In this study we analyzed the trends and determinants of minimum dietary diversity (MDD) among Ethiopian children aged 6 to 59 mo. Methods Ethiopian Demographic Health Survey (EDHS) data of 3 consecutive years (2005, 2011, and 2016) were analyzed. A total of n = 2396 (2005), n = 3385 (2011), and n = 3723 (2016) children aged 6 to 59 mo were included for measurement of trends and identification of the determinants of MDD. The associations between the study factors and MDD were investigated using multiple logistic regression analysis. Results The proportion of children who fulfilled the MDD decreased from 2.46% in 2005 to 1.57% in 2011 but sharply increased to 7.82% in 2016. Adjusted regression analysis revealed that exposure of mothers to media, particularly watching television, maternal education, and household wealth were associated with a greater likelihood of mothers providing diversified diets to their children across the 3 y of EDHS data. Conclusions A decrease in MDD was observed from the years 2005 to 2011, after which a sharp increase was noted in 2016. In all 3 y of the EDHS, media exposure, maternal education, and household wealth were the consistent factors positively affecting dietary diversity among children aged 6 to 59 mo. Future intervention programs to increase dietary diversity in children should emphasize improving access to media exposure, education, and antenatal care visits.
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Affiliation(s)
- Dassalegn Daraje Jalata
- Food Science and Nutrition Research Department, Ethiopian Institute of Agricultural Research, Addis Ababa, Ethiopia
| | - Bezuayehu Gutema Asefa
- Food Science and Nutrition Research Department, National Fishery and Aquatic Life Research Center, Ethiopian Institute of Agricultural Research, Sebeta, Ethiopia
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Predictors of Minimum Acceptable Diet among Children Aged 6-23 Months in Nepal: A Multilevel Analysis of Nepal Multiple Indicator Cluster Survey 2019. Nutrients 2022; 14:nu14173669. [PMID: 36079926 PMCID: PMC9460334 DOI: 10.3390/nu14173669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Minimum Acceptable Diet (MAD), developed by the WHO and UNICEF, is a binary indicator of infant and young child feeding practice that assesses the quality and sufficiency of a child’s diet between the ages of 6 and 23 months. Identifying factors associated with MAD among children can inform policymakers to improve children’s nutritional status. Methods: We extracted data of 1930 children aged 6–23 months from the Nepal Multiple Indicator Cluster Survey 2019. Multilevel analysis was performed to identify factors associated with MAD. Results: Only 30.1% of the children received MAD. Children aged 13–18 months [aOR (Adjusted odds ratio): 2.37, 95% CI (95% Confidence Interval): 1.77, 3.17] and 19–23 months (aOR: 2.6, 95% CI: 1.95, 3.47) were more likely to receive MAD than children aged 6–12 months. Early breastfed children (aOR: 1.34, 95% CI: 1.05, 1.72), those currently breastfeeding (aOR: 4.13, 95% CI: 2.21, 7.69) and children without siblings aged under five (aOR: 1.33, 95% CI: 1.03, 1.73) were more likely to receive MAD. Younger maternal age (aOR: 0.97, 95% CI: 0.95–1.0), higher level of mother’s education (aOR: 1.04, 95% CI: 1.0–1.08) and more media exposure among mothers (aOR: 1.66, 95% CI: 1.24, 2.21) were positive predictors of MAD. Relatively disadvantaged ethnicity/caste (aOR: 0.71, 95% CI: 0.53, 0.94), rural residence (aOR: 1.45, 95% CI: 1.06, 2.00) and residing in Madhesh province (aOR: 0.61, 95% CI: 0.37, 1.0) were also significant predictors of MAD. Conclusions: Children aged 6–12 months, without appropriate breastfeeding, having under-five years siblings, with older mother or mother without media exposure or low education, from relatively disadvantaged ethnicity/caste, from urban areas and residing in Madhesh Province were less likely to receive MAD. Our findings can inform infant and young child feeding policies and practices in Nepal.
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Trends in Complementary Feeding Indicators and Intake from Specific Food Groups among Children Aged 6-23 Months in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010550. [PMID: 35010809 PMCID: PMC8745020 DOI: 10.3390/ijerph19010550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 12/04/2022]
Abstract
The present study aims to comprehensively analyse trends in complementary feeding indicators (Introduction of solid, semi-solid, and soft foods at 6–8 months (INTRO), Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD)) among children aged 6–23 months in Bangladesh. The study used data from four rounds (2007, 2011, 2014, and 2017–2018) of nationally representative Bangladesh Demographic and Health Surveys (BDHSs). The Cochran–Armitage test was performed to capture the trends in complementary feeding practices and intake from specific food groups. BDHSs are periodically conducted cross-sectional surveys in all seven administrative divisions of Bangladesh. The present analysis was performed among 8116 children (1563 in 2007, 2137 in 2011, 2249 in 2014, and 2167 in 2017–2018) aged 6–23 months. Overall, a decreasing trend was observed in all the complementary feeding indicators except INTRO from 2007 to 2014, but a substantial increase in MDD, MMF and MAD was noted in 2017–2018. A statistically significant reduction in consumption from different food groups such as legumes and nuts (p < 0.001), dairy products (p = 0.001), vitamin-A-rich fruits or vegetables (p < 0.001), and other fruits and vegetables (p < 0.001) was also observed. However, a positive trend was noted in the consumption of grains/roots/tubers (p = 0.027), and meat/fish/egg (p < 0.001). After experiencing a significant decreasing trend during 2007–2014, the recent BDHS indicates improvements in all complementary feeding indicators among young children in Bangladesh, which calls for integrated, multisectoral, and multicomponent interventions to sustain this progress.
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Setu SP, Islam MA, Halim SFB. Individual and Community-Level Determinants of Institutional Delivery Services among Women in Bangladesh: A Cross-Sectional Study. Int J Clin Pract 2022; 2022:3340578. [PMID: 35685544 PMCID: PMC9159142 DOI: 10.1155/2022/3340578] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Improving maternal mortality attracts considerable interest with the critical invention through institutional delivery services (IDS) in reducing maternal death during delivery and ensuring safe childbirth. The influence of both individual and community-level factors is essential to using IDS. Problem Statement. Maternal death may occur at any time, but delivery without designated healthcare is by far the most dangerous time for both woman and her baby. Therefore, to combat the global burden of maternal mortality, it is necessary to ensure IDS worldwide. OBJECTIVES This study explores the current knowledge of individual and community-level covariates and examines their extent of influence on the utilization of IDS in Bangladesh. METHODS Utilizing Bangladesh Demographic and Health Survey (BDHS) data, this study has used two-level random intercept binary logistic regression, together with the average annual rate of increase (AARI) in the utilization of IDS and related variables. RESULTS This study found appreciable changes in seeking IDS, increases from 3.4% in 2007 to 51.9% in 2017, and half of the total deliveries (51%) took place in healthcare. About 26% of the total variation in the utilization of IDS is owing to differences across communities. Further, covariates including communities with higher educated women, higher utilization of ANC and access to media and at individual level, religion, maternal and parental education, wealth index, and mother-level factors (i.e., age at birth, BMI, occupation, ANC visit, birth order, own health care decision, pregnancy intention, and exposure to media) showed significant association with the utilization of IDS. CONCLUSION This study observed the association between individual and community-level factors and IDS uptake. Thus, any future strategies must address individual level and community-level challenges and undertake a multisectoral approach to enhance the uptake of IDS.
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Affiliation(s)
- Sarmistha Paul Setu
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Md. Akhtarul Islam
- Statistics Discipline, Science Engineering & Technology School, Khulna University, Khulna 9208, Bangladesh
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Hanley‐Cook G, Argaw A, Dahal P, Chitekwe S, Rijal S, Bichha RP, Parajuli KR, Kolsteren P. Elucidating the sustained decline in under-three child linear growth faltering in Nepal, 1996-2016. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 1:e12982. [PMID: 32141213 PMCID: PMC8770651 DOI: 10.1111/mcn.12982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2011, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjusted p < .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal. [Correction added on 6 November 2020, after first online publication: in abstract, the citation year in the fourth sentence has been changed from '2001' to '2011'.].
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Affiliation(s)
- Giles Hanley‐Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
- Department of Population and Family Health, Institute of HealthJimma UniversityJimmaEthiopia
| | - Pradiumna Dahal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Stanley Chitekwe
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Sanjay Rijal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | - Ram Padarath Bichha
- Department of Health Services, Ministry of Health and PopulationGovernment of NepalKathmanduNepal
| | - Kedar Raj Parajuli
- Department of Health Services, Ministry of Health and PopulationGovernment of NepalKathmanduNepal
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
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Hanley‐Cook G, Argaw A, Dahal P, Chitekwe S, Kolsteren P. Infant and young child feeding practices and child linear growth in Nepal: Regression-decomposition analysis of national survey data, 1996-2016. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 1:e12911. [PMID: 31922348 PMCID: PMC8770650 DOI: 10.1111/mcn.12911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and height-for-age z-score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001-2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996-2016 period. Our findings indicate that most age-appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's tool for national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle-feeding and introduction of solid, semi-solid or soft foods are rated fair. Our study also reports that a paucity of age-appropriate IYCF practices-in particular complementary feeding-are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, age-appropriate IYCF practices-in isolation-made modest statistical contributions to the rapid and sustained reduction in age-specific child linear growth faltering from 1996-2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies-integrating and advocating optimal IYCF-are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle-feeding.
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Affiliation(s)
- Giles Hanley‐Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
- Department of Population and Family Health, Institute of HealthJimma UniversityJimmaEthiopia
| | - Pradiumna Dahal
- Nutrition Section, United Nations Children's Fund (UNICEF)KathmanduNepal
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF)KathmanduNepal
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
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Paramashanti BA, Huda TM, Alam A, Dibley MJ. Trends and determinants of minimum dietary diversity among children aged 6-23 months: a pooled analysis of Indonesia Demographic and Health Surveys from 2007 to 2017. Public Health Nutr 2021; 25:1-12. [PMID: 34743776 PMCID: PMC9991623 DOI: 10.1017/s1368980021004559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine minimum dietary diversity (MDD) trends and determinants among children aged 6-23 months. DESIGN Secondary analysis of the Indonesia Demographic and Health Surveys (IDHS) between 2007 and 2017. The primary outcome was MDD, the consumption of at least five out of eight food groups (MDD-8). We included a total of 5015 (IDHS 2007), 5050 (IDHS 2007) and 4925 (IDHS 2017) children aged 6 to 23 months to estimate trends of MDD-8 and to identify factors associated with MDD-8. We used multiple logistic regression analysis adjusted for the complex sampling design to investigate the association between the study factors and MDD-8. SETTING Indonesia. PARTICIPANT A total of 14 990 children aged 6-23 months. RESULTS Over the 10 years, the percentage of children who consumed a diversified diet was 53·1 % in 2007, 51·7 % in 2012 and 53·7 % in 2017. Multivariate analyses showed that older age children, higher maternal education, maternal weekly access to media, paternal non-agricultural occupation, history of at least four antenatal care visits and wealthier households were associated with the increased odds of MDD-8. Children living in rural areas, Sulawesi and Eastern Indonesia, were less likely to eat a diversified diet. CONCLUSIONS The proportion of children meeting MDD-8 has stagnated in the last decade. Child, parental, health care, household and community factors are associated with MDD-8. Therefore, nutrition education programmes and behaviour change communication activities should target mothers and families from socio-economically and geographically disadvantaged populations.
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Affiliation(s)
- Bunga A Paramashanti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
- Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta55183, Indonesia
| | - Tanvir M Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW2006, Australia
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Shaker‐Berbari L, Qahoush Tyler V, Akik C, Jamaluddine Z, Ghattas H. Predictors of complementary feeding practices among children aged 6-23 months in five countries in the Middle East and North Africa region. MATERNAL & CHILD NUTRITION 2021; 17:e13223. [PMID: 34137179 PMCID: PMC8476411 DOI: 10.1111/mcn.13223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 01/13/2023]
Abstract
Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low- and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.
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Affiliation(s)
- Linda Shaker‐Berbari
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Vilma Qahoush Tyler
- United Nations Children's Fund (UNICEF) Regional Office for Middle East and East Africa RegionAmmanJordan
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Zeina Jamaluddine
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
- London School of Hygiene and Tropical MedicineLondonUK
| | - Hala Ghattas
- Center for Research on Population and Health, Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
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Chitekwe S, Torlesse H, Aguayo VM. Nutrition in Nepal: Three decades of commitment to children and women. MATERNAL AND CHILD NUTRITION 2021; 18 Suppl 1:e13229. [PMID: 34523803 PMCID: PMC8770654 DOI: 10.1111/mcn.13229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/20/2022]
Abstract
South Asia has made significant progress in reducing child undernutrition. The prevalence of stunting declined by one third between 2000 and 2019; as a result, in 2019, there were 34 million fewer stunted children than in 2000, indicating that progress for child nutrition is possible and is happening at scale. However, no country in South Asia is on track for all nutrition targets of Sustainable Development Goal 2, and the region has the highest prevalence of stunting (33.2%) and wasting (14.8%) in the world. Nepal, the best performing country in the region, narrowly missed the Millennium Development Goal (MDG) target to half the prevalence of child underweight between 1990 and 2015 and achieved the fastest recorded reduction in stunting prevalence in the world between 2001 and 2011. In 2019, UNICEF Nepal completed a series of papers to examine Nepal's progress on maternal and child nutrition during the MDG era. The series explores the trends, distribution and disparities in stunting, micronutrient deficiencies and feeding practices in children under 5 years and anaemia in adolescents and women. Besides, it reviews national micronutrient programmes (vitamin A supplementation, iron and folic acid supplementation and universal salt iodization) and Nepal's first Multi-Sector Nutrition Plan, to illuminate the success factors and enduring challenges in the policy and programme landscape for nutrition. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy and programme actions to improve maternal and child nutrition in Nepal and other similar contexts.
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Affiliation(s)
- Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Harriet Torlesse
- Nutrition Section, Regional Office for South Asia, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Victor M Aguayo
- Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
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Akalu Y, Yeshaw Y, Tesema GA, Demissie GD, Molla MD, Muche A, Diress M, Tiruneh SA. Iron-rich food consumption and associated factors among children aged 6-23 months in sub-Saharan Africa: A multilevel analysis of Demographic and Health Surveys. PLoS One 2021; 16:e0253221. [PMID: 34138916 PMCID: PMC8211154 DOI: 10.1371/journal.pone.0253221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Anemia remains a major public health problem for children in sub-Saharan Africa (SSA). Iron-rich foods consumption has a determinant role on the anemia status. Hence, this study aimed to determine the prevalence of good consumption of iron-rich foods and its associated factors among children aged 6-23 months in SSA. MATERIALS AND METHODS The recent Demographic and Health Survey data sets of thirty-five SSA countries were used. Data were analyzed using STATA/MP version 16.0 and all statistical analyses were done after weighting the data. A generalized linear mixed model using Poisson regression with robust error variance was used to determine factors associated with good consumption of iron-rich food. Association of variables was declared at a p-value of ≤0.05 and adjusted prevalence ratio (aPR) ratio with its 95% confidence interval (CI) was calculated for each variable. RESULTS The total weighted samples of 77,001 children aged 6-23 months were included. The prevalence of consumption of iron rich foods was 42.1% (95% CI: 41.78-42.48). Children with age of 12-17 (adjusted prevalence ratio (aPR) = 1.96, 95% CI: 1.89-2.04) and 18-23 months (aPR = 2.05, 95% CI: 1.97-2.14), who took drugs for intestinal parasites (aPR = 1.30, 95% CI: 1.26-1.34), with postnatal check within 2 months (aPR = 1.09, 95% CI: 1.06-1.13), and children from women with ANC visit of 1-3 (aPR = 1.31, 95% CI: 1.24-1.37) and ≥4 (aPR = 1.41, 95% CI: 1.34-1.48) had higher prevalence of good consumption of iron rich foods. Moreover, the prevalence of consumptions of iron rich foods was higher among children from; family with rich (aPR = 1.36, 95%CI: 1.30-1.42) and middle (aPR = 1.14 95% CI: 1.09-1.19) wealth index, and mother with media exposure (aPR = 1.26, 95%CI: 1.22-1.31). CONCLUSION The prevalence of good consumption of iron-rich foods among children aged 6-23 months in SSA countries is low. Child factors, family factors, and community-level factors were significantly associated with consumption of iron rich foods. Strategies to increase the consumption of iron-rich foods during this critical stage of growth and development should be designed in SSA.
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Affiliation(s)
- Yonas Akalu
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getu Debalkie Demissie
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Muche
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistie Diress
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Dhami MV, Ogbo FA, Akombi-Inyang BJ, Torome R, Agho KE. Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review. Nutrients 2021; 13:825. [PMID: 33801545 PMCID: PMC7998710 DOI: 10.3390/nu13030825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/30/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.
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Affiliation(s)
- Mansi Vijaybhai Dhami
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia; (F.A.O.); (K.E.A.)
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia; (F.A.O.); (K.E.A.)
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, SA 5345, Australia;
| | - Blessing Jaka Akombi-Inyang
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia;
- School of Social Sciences, Western Sydney University, Penrith, NSW 2571, Australia
| | - Raphael Torome
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, SA 5345, Australia;
| | - Kingsley Emwinyore Agho
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2571, Australia; (F.A.O.); (K.E.A.)
- School of Health Sciences, Western Sydney University, Penrith, NSW 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban 4041, South Africa
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Minimum dietary diversity and associated factors among young infants and children living in the most productive area of Amhara region, Addis Zemen town: A community-based cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ariff S, Saddiq K, Khalid J, Sikanderali L, Tariq B, Shaheen F, Nawaz G, Habib A, Soofi SB. Determinants of infant and young complementary feeding practices among children 6-23 months of age in urban Pakistan: a multicenter longitudinal study. BMC Nutr 2020; 6:75. [PMID: 33323127 PMCID: PMC7739450 DOI: 10.1186/s40795-020-00401-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal feeding practices have a negative impact on children’s health and growth in the first 2 years of life and increase their risk of undernutrition, morbidity, and mortality. The aim of the study was to assess the factors that influence infant and young child feeding practices among urban mothers in a hospital setting at Karachi, Pakistan. Methods A longitudinal multi-center cohort study was conducted in four countries, MULTICENTER BODY COMPOSITION REFERENCE STUDY (MBCRS) to produce normal body composition reference data in healthy infants from 3 months to 24 months of age. Repeated anthropometric (weight, length and head circumference) and body composition measurements using “deuterium dilution method” along with 24-h dietary recall questionnaires were performed on 250 healthy term infants at 3, 6, 9, 12, 18, and 24 months of age. The 24-h dietary recall data from this study was used to assess the breastfeeding and complementary feeding practices in children aged 6–24 months. Results A total of 250 healthy infants were enrolled in the study. A majority of newborns (75.4%) were exclusively breastfed till 3 months of age; however, by 6 months of age, only 30.2% of infants were exclusively breastfed. Only 44.1% of children aged 6–24 months achieved minimum dietary diversity (MDD), 84.7% achieved minimum meal frequency (MMF), and 44.1% achieved a minimum acceptable diet (MAD). 71.4% achieved MDD and MAD and 100% achieved MMF at 24 months. The bivariate analysis found that breastfed children (OR 3.93, 95% CI 2.72–5.68), with employed mothers (OR 1.55, 95% CI 1.06–2.27) who had graduated from secondary school (OR 1.45, 95% CI 1.08–1.94) were more likely to meet minimum dietary diversity. The multivariable analysis showed that only the child’s age was significantly associated with MDD (p value< 0.0001), with the likelihood of meeting MDD increasing as the children aged; 9 months (OR 18.96, 95% CI 6.63–54.19), 12 months (OR 40.25, 95% CI 14.14–114.58), 18 months (OR 90.02, 95% CI 30.84–262.77) and 24 months (OR 82.14, 95% CI 27.23–247.83). Conclusion Our study revealed that Infant and young child feeding practices are significantly associated with maternal education, employment, and the child’s age. Therefore, it is essential that investments be made towards protective breastfeeding and complementary feeding policies and legislations, emphasis on female education and ensuring the availability of affordable nutritious and diverse foods.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kamran Saddiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Javairia Khalid
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Laila Sikanderali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Batha Tariq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fariha Shaheen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Atif Habib
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Leonez DGVR, Melhem ARDF, Vieira DG, de Mello DF, Saldan PC. COMPLEMENTARY FEEDING INDICATORS FOR CHILDREN AGED 6 TO 23 MONTHS ACCORDING TO BREASTFEEDING STATUS. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2020; 39:e2019408. [PMID: 33111770 PMCID: PMC7584029 DOI: 10.1590/1984-0462/2021/39/2019408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To verify if there are differences among the complementary feeding indicators of children aged 6-23 months according to the breastfeeding status. METHODS A cross-sectional study was carried out with 1,355 children aged 6-23 months in 2012 to evaluate five indicators proposed by the World Health Organization (WHO) and modified in accordance with Brazilian's recommendations "Ten steps to a healthy feeding: a feeding guide for children under two years old". The indicators used were: I. Introduction of solid, semi-solid or soft foods; II. Minimum dietary diversity; III. Minimum meal frequency; IV. Minimum acceptable diet, and V. Consumption of iron-rich foods. To verify differences between the complementary feeding indicators according to breastfeeding status, the F-statistic was used, with p≤0.05 meaning significant. RESULTS Indicators I, II, and V were similar among breastfed and non-breastfed children; however, indicators III and IV presented a higher proportion of adequacy for non-breastfed children, with 94.9% (CI95% 93.2-96.2) versus 40.3% (CI95% 33.2-47.9) for indicator III, and 57.3% (CI95% 53.2-61.2) versus 23.1% (CI95% 17.4-30.1) for indicator IV. CONCLUSIONS Non-breastfed children have better complementary feeding status, but the indicator III takes into account non-breast milk as a meal for non-breastfed children, which increased the number of dairy meals and influenced indicator IV (calculated from indicators II and III).
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Singh DR, Ghimire S, Upadhayay SR, Singh S, Ghimire U. Food insecurity and dietary diversity among lactating mothers in the urban municipality in the mountains of Nepal. PLoS One 2020; 15:e0227873. [PMID: 31935272 PMCID: PMC6959598 DOI: 10.1371/journal.pone.0227873] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/31/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adequate nutrition is essential during the lactation period for better maternal and child health outcomes. Although food insecurity and dietary monotony (defined as less diverse diet), two important determinants of undernutrition, are endemic in the rural mountains of Nepal, insufficiently examined and assessed for risk factors in mothers during lactation, a life stage of high nutritional demand. This study aimed to assess the status and factors associated with food insecurity and dietary diversity among lactating mothers residing in the mountains of Nepal. METHODS A community-based cross-sectional study was conducted in an urban municipality in the mountainous Bajhang District of far-western Nepal. The sampling frame and strategy led to 417 randomly selected lactating mothers. Household Food Insecurity Access Scale (HFIAS) and the tool "Minimum Dietary Diversity for Women" developed by the Food and Agriculture Organization were used to measure food insecurity and dietary diversity, respectively. Additional information on socio-demographics and risk factors were collected. Multivariable logistics regression assessed correlates of study outcomes. RESULTS Overall, 54% of the households were food insecure, and over half (53%) of the mothers had low dietary diversity. Food insecurity status (mild food insecurity AOR = 10.12, 95% CI = 4.21-24.34; moderate food insecurity AOR = 8.17, 95% CI = 3.24-20.59, and severe food insecurity AOR = 10.56, 95% CI = 3.92-28.43) were associated with higher odds of dietary monotony. Likewise, participants with lower dietary diversity were 8.5 times more likely to be food insecure than those with higher dietary diversity (AOR = 8.48, 95% CI = 3.76-19.14). The monthly income of the family was positively associated with food insecurity. Participants' (AOR = 3.92 95%CI = 1.76-8.71) or spouses' (AOR = 2.90, 95% CI = 1.07-7.85) unemployment was associated with higher odds of being food insecure. Likewise, owning a cultivable land (AOR = 0.49, 95% CI = 0.28-0.84) and participant's unemployment status (AOR = 5.92, 95% CI = 3.02-11.63), were significantly associated with increased odds of dietary monotony. CONCLUSION The observed food insecurity and poor dietary diversity among lactating mothers, the correlates associated with these outcomes, may help local stakeholders to identify local health needs and subgroups for targeted interventions. Socioeconomically disadvantaged mothers should be specifically targeted for relevant programs and policies.
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Affiliation(s)
- Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Satdobato, Lalitpur, Nepal
- Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, United States of America
| | - Satya Raj Upadhayay
- Department of Public Health, National Open College, Pokhara University, Sanepa, Lalitpur, Nepal
| | - Sunita Singh
- Central Department of Home Science, Padma Kanya Campus, Tribhuvan University, Kathmandu, Nepal
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Ahmed KY, Page A, Arora A, Ogbo FA. Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016. MATERNAL AND CHILD NUTRITION 2019; 16:e12926. [PMID: 31833239 PMCID: PMC7083482 DOI: 10.1111/mcn.12926] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
Abstract
Introducing appropriate complementary feeding at 6 months of age is crucial for the optimal growth and development of an infant. In Ethiopia, however, no previous national‐level studies have examined the trends and associated factors of complementary feeding practices. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016. The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2,520), 2011 (N = 2,850), and 2016 (N = 2,864). Percentage point changes in complementary feeding indicators were estimated to examine the trends over the EDHS years. Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service, and community‐level factors and (a) the introduction of complementary foods, (b) minimum dietary diversity (MDD), (c) minimum meal frequency (MMF), and (d) minimum acceptable diet (MAD). The proportion of mothers who met MDD increased from 6.3% to 13.5% (p < .001), and MAD increased from 4.1% to 7.1% (p = .003) from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%, p = .051) and MMF (from 41.3% to 43.6%, p = .288) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF, and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD. Our analysis of the EDHS suggests that the proportion of MDD and MAD were unacceptably low. Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage, and media exposure.
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Affiliation(s)
- Kedir Y Ahmed
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.,College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.,School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia.,General Practice Unit, Prescot Specialist Medical Centre, Makurdi, Nigeria
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Shrestha L, Parmar A, Kulig B, Hensel O, Sturm B. Feeding practices of pre-school children and associated factors in Kathmandu, Nepal. J Hum Nutr Diet 2019; 33:241-251. [PMID: 31680361 DOI: 10.1111/jhn.12715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In developing countries such as Nepal, many children aged below 3 years do not grow at a sufficiently high rate and are vulnerable to micronutrient deficiencies (e.g. vitamin A). Challenges to child nutrition can result from poverty, unhealthy traditional practices, inadequate caring and feeding practices. The present study aimed to assess the feeding practices of pre-school children and their associated factors. METHODS A cross-sectional study was carried out in pre-schools located in Kathmandu district between February and March 2018. Three levels in terms of price range (lower, medium and higher level) of pre-schools were selected to reach the mothers of children aged ≤3 years. A structured questionnaire was administered to 145 mothers. Descriptive analyses were conducted to observe the characteristics of the population. Multinomial logistic regression analyses were performed to identify the association for the factors of mothers' perception of their current feeding practices. RESULTS We found that dal-bhat/jaulo was a common complementary food irrespective of socio-economic background. Interestingly, mothers who had received a higher education were significantly less likely to change their feeding practices (odds ratio = 0.118, confidence interval = 0.01-0.94). The mothers that fed a higher quantity porridge to their children showed a high willingness to change the feeding practices. CONCLUSIONS Poor feeding practices are still an important public health problem in Nepal and were observed to be associated with low socio-economic status, unawareness and a lack of knowledge towards dietary diversity combined with strong beliefs related to social forces and cultures.
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Affiliation(s)
- L Shrestha
- Department of Agricultural and Biosystems Engineering, University of Kassel, Witzenhausen, Germany
| | - A Parmar
- Natural Resources Institute, University of Greenwich, Chatham Maritime, UK
| | - B Kulig
- Department of Agricultural and Biosystems Engineering, University of Kassel, Witzenhausen, Germany
| | - O Hensel
- Department of Agricultural and Biosystems Engineering, University of Kassel, Witzenhausen, Germany
| | - B Sturm
- Department of Agricultural and Biosystems Engineering, University of Kassel, Witzenhausen, Germany.,School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Kang Y, Kim J. Risk factors for undernutrition among children 0-59 months of age in Myanmar. MATERNAL & CHILD NUTRITION 2019; 15:e12821. [PMID: 30919554 PMCID: PMC6859997 DOI: 10.1111/mcn.12821] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 02/02/2023]
Abstract
The prevalence of childhood stunting in Myanmar is one of the highest among the countries of Southeast Asia. Cross-sectional data from the Myanmar Demographic Health Survey 2015-2016 were used to examine risk factors for stunting, wasting, and underweight among children aged 0-59 months. The prevalence of stunting, wasting, and underweight was 29.0%, 7.3%, and 19.2%, respectively. Accounting for sampling design and weights, multivariable logistic regression was conducted with 35 household, maternal, and child characteristics. Current pregnancy and maternal height <145 cm, home delivery, child's small birth size recalled by mother, and older age (ref: 0-5 months) predicted both stunting and underweight. Larger than average birth size was protective for all stunting, wasting, and underweight. Maternal body mass index <18.5 kg m-2 was a common risk factor for wasting and underweight. Lower wealth quintiles, maternal engagement in nonagricultural occupation, and male child predicted stunting only. Younger child age and not receiving vitamin A supplementation in the previous 6 months were risk factors for wasting only. Regional variation was also seen, with a higher odds of stunting in the West-South Region, North-East States, and West States, compared with the Central Regions. In Myanmar, socio-economic and demographic factors, poor maternal nutritional status, and living in certain geographical locations are affecting children's undernutrition. It is recommended that interventions for growth faltering focus on the first 1,000 days of life; optimum maternal nutrition be ensured during and before pregnancy and at adolescence; societal support be provided for mothers in poverty or engaged in nonagriculture; and region-specific undernutrition pathways be understood.
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Affiliation(s)
- Yunhee Kang
- Center for Human NutritionJohns Hopkins School of Public HealthBaltimoreMarylandUSA
| | - Jihye Kim
- Department of Medical Nutrition, Graduate School of East‐West Medical ScienceKyung Hee UniversityYonginSouth Korea
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24
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Stewart CP, Caswell B, Iannotti L, Lutter C, Arnold CD, Chipatala R, Prado EL, Maleta K. The effect of eggs on early child growth in rural Malawi: the Mazira Project randomized controlled trial. Am J Clin Nutr 2019; 110:1026-1033. [PMID: 31386106 PMCID: PMC6766435 DOI: 10.1093/ajcn/nqz163] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stunted growth is a significant public health problem in many low-income countries. OBJECTIVE The aim of this study was to evaluate the impact of 1 egg per day on child growth in rural Malawi. DESIGN We conducted an individually randomized controlled trial in which 660 children aged 6-9 mo were equally allocated into an intervention (1 egg/d) or control group. Eggs were provided during twice-weekly home visits for 6 mo. Control households were visited at the same frequency. Assessors blinded to intervention group measured length, weight, head circumference, and midupper arm circumference at baseline and the 6-mo follow-up visit. To assess adherence, multipass 24-h dietary recalls were administered at baseline, 3-mo, and 6-mo visits. RESULTS Between February and July 2018, 660 children were randomly assigned into the intervention (n = 331) and control (n = 329) groups. Losses to follow-up totaled 10%. In the intervention group, egg consumption increased from 3.9% at baseline to 84.5% and 70.3% at the 3-mo and 6-mo visits, whereas in the control group, it remained below 8% at all study visits. The baseline prevalence of stunting was 14%, underweight was 8%, and wasting was 1% and did not differ by group. There was no intervention effect on length-for-age, weight-for-age, or weight-for-length z scores. There was a significantly higher head circumference for age z score of 0.18 (95% CI: 0.01, 0.34) in the egg group compared with the control group. There was a significant interaction with maternal education (P = 0.024), with an effect on length-for-age z score only among children whose mothers had higher education. CONCLUSIONS The provision of 1 egg per day to children in rural Malawi had no overall effect on linear growth. A background diet rich in animal source foods and low prevalence of stunting at baseline may have limited the potential impact. This trial was registered at clinicaltrials.gov as NCT03385252.
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Affiliation(s)
| | - Bess Caswell
- Department of Nutrition, University of California, Davis, CA, USA
| | - Lora Iannotti
- Brown School, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Chessa Lutter
- RTI International, Washington DC, School of Public Health, University of Maryland, College Park, MD, USA
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, CA, USA
| | - Raphael Chipatala
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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25
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Na M, Aguayo VM, Arimond M, Mustaphi P, Stewart CP. Predictors of complementary feeding practices in Afghanistan: Analysis of the 2015 Demographic and Health Survey. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12696. [PMID: 30499256 PMCID: PMC6587761 DOI: 10.1111/mcn.12696] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi-solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6-8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6-23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community-level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda.
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Affiliation(s)
- Muzi Na
- Department of Nutritional Sciences, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York
| | - Mary Arimond
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC
| | - Piyali Mustaphi
- Nutrition Section, United Nations Children's Fund (UNICEF), Kabul, Afghanistan
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California
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26
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Torlesse H, Aguayo VM. Aiming higher for maternal and child nutrition in South Asia. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12739. [PMID: 30499249 PMCID: PMC6588023 DOI: 10.1111/mcn.12739] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
The sustainable development of nations relies on children developing to their full potential and leading healthy, productive, and prosperous lives. Poor nutrition in early life threatens the growth and development of children, especially so in South Asia, which has the highest burdens of stunting, wasting, and anaemia in the world. Targeted actions to reduce stunting and other forms of child malnutrition in South Asia should be informed by an understanding of what drives poor nutrition in children, who is most affected, and effective programme approaches. To this end, the UNICEF Regional Office for South Asia commissioned a series of papers in 2016–2017 to fill knowledge gaps in the current body of evidence on maternal and child nutrition in South Asia, including analyses of: (a) the links between anthropometric failure in children and child development; (b) the time trends, current distribution, disparities and inequities of child stunting, wasting and anaemia, and their direct and underlying causes, including maternal anaemia, low birth weight, breastfeeding, and complementary feeding; (c) policy and programme actions to increase the coverage of nutrition interventions during pregnancy, improve breastfeeding practices, and care for severely wasted children. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy, and programme actions to improve maternal and child nutrition in South Asia.
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Affiliation(s)
- Harriet Torlesse
- Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, UNICEF, New York, New York
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27
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Pries AM, Sharma N, Upadhyay A, Rehman AM, Filteau S, Ferguson EL. Energy intake from unhealthy snack food/beverage among 12-23-month-old children in urban Nepal. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 4:e12775. [PMID: 31225707 PMCID: PMC6617731 DOI: 10.1111/mcn.12775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 01/06/2023]
Abstract
Unhealthy snack food and beverage (USFB) consumption among young children has been noted in many low‐income and middle‐income countries (LMIC), however, there is a lack of information on the contribution of these foods to children's diets in these contexts. This study describes the nutrient profiles and costs of snacks consumed by young children in Kathmandu Valley, Nepal, and assesses the proportion of total energy intake from nonbreastmilk foods (%TEI‐NBF) contributed by USFB and factors associated with high USFB consumption. A cross‐sectional survey was conducted among 745 randomly sampled primary caregivers of children aged 12–23 months. Of 239 unique snack foods and beverages consumed, 180 (75.3%) were classified as unhealthy based on nutrient profiling, with 158 of these being commercially branded. Median cost/100 kcal of USFB was lower as compared with healthy snacks. Ninety‐one percent of children had consumed a USFB in the previous 24 hr, with these foods contributing a mean %TEI‐NBF of 24.5 ± 0.7 among all children. Biscuits (10.8%), candy/chocolate (3.5%), and savoury snacks (3.4%) provided the largest %TEI‐NBF. Children who were older, female, or from the poorest households had significantly higher odds of high USFB consumption, whereas children whose caregivers were of upper caste/ethnicity or had achieved tertiary education had lower odds of consumption than other children. To reduce USFB consumption, interventions should seek to further understand social/cultural drivers of feeding practices, target disadvantaged populations, and ensure caregivers are fully aware of the nutritional quality of food products they choose for their children.
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Affiliation(s)
- Alissa M Pries
- Helen Keller International, New York, New York.,Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Andrea M Rehman
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine L Ferguson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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28
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Baek Y, Chitekwe S. Sociodemographic factors associated with inadequate food group consumption and dietary diversity among infants and young children in Nepal. PLoS One 2019; 14:e0213610. [PMID: 30856209 PMCID: PMC6411102 DOI: 10.1371/journal.pone.0213610] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/25/2019] [Indexed: 12/02/2022] Open
Abstract
Infants and young children need diversified diets to grow healthy. However, there is limited evidence on factors associated with consumption of various food groups. This study aimed to identify the sociodemographic factors associated with inadequate food group consumption and not meeting the minimum dietary diversity (MDD) among infants and young children aged 6-23 months in Nepal. Using cross-sectional data from the 2016 Nepal Demographic and Health Survey, the factors at the individual-, household-, and community-levels associated with not consuming foods from the seven food groups, which are grains, roots and tubers, legumes and nuts, dairy products, flesh foods, eggs, vitamin-A rich fruits and vegetables, and other fruits and vegetables, and not meeting the MDD were examined. The least consumed food group was eggs, followed by flesh foods and 46.5% of children received the MDD. Children aged 6-11 months had higher odds of not consuming foods from the seven food groups and not meeting the MDD than older children. Children from the poorest quintile had higher odds of not consuming legumes and nuts, dairy products, flesh foods, and other fruits and vegetables, and not meeting the MDD. Children from Terai/Madhesi Other had higher odds of not consuming foods from the seven food groups compared to those from the other groups. Children from Province 2 had higher odds of not consuming eggs, vitamin-A rich fruits and vegetables, and other fruits and vegetables, and not meeting the MDD. Dietary diversity among children in Nepal needs improvement. National policies and programs need to promote the consumption of diverse food groups by considering different sociodemographic characteristics.
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Affiliation(s)
- Yeji Baek
- United Nations Children’s Fund (UNICEF) Nepal, UN House, Pulchowk, Kathmandu, Nepal
| | - Stanley Chitekwe
- United Nations Children’s Fund (UNICEF) Nepal, UN House, Pulchowk, Kathmandu, Nepal
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29
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Angdembe MR, Dulal BP, Bhattarai K, Karn S. Trends and predictors of inequality in childhood stunting in Nepal from 1996 to 2016. Int J Equity Health 2019; 18:42. [PMID: 30836975 PMCID: PMC6402091 DOI: 10.1186/s12939-019-0944-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/25/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although decreasing in trend, one-in-three children remain stunted in Nepal and its distribution is unequal among different socioeconomic and geographical subgroups. Thus, it is crucial to assess inequalities in stunting for designing equity focused interventions that target vulnerable groups with higher burden of stunting. This study measures trends and predictors of socioeconomic inequalities in childhood stunting in Nepal. METHODS Data from five rounds (1996-2016) of Nepal Demographic and Health Survey, nationally representative cross-sectional surveys, were used. Levels and trends of absolute and relative disparity in stunting between the poorest and the richest wealth quintiles, and among all quintiles were assessed by calculating absolute and relative difference, concentration curve and index. Average marginal effects of predictors on stunting were calculated using probit regression. The concentration index was subsequently decomposed into contributing factors. RESULTS Even though stunting consistently declined in all wealth quintiles between 1996 and 2016, reduction was relatively higher among the richer quintiles compared to poorer ones. The absolute difference between the poorest and the richest quintile increased from 24.7 in 1996 (64.5% in poorest - 39.8% in richest) to 32.7 percentage points in 2016 (49.2-16.5%). The relative disparity also increased; the ratio of stunting in the poorest to the richest quintile was 1.6 in 1996 and 3.0 in 2016. The concentration index increased (in absolute value) from - 0.078 in 1996 to - 0.147 in 2016 indicating that stunting was disproportionately concentrated in poorer households and socioeconomic inequalities worsened from 1996 to 2016. Decomposition analysis revealed that in 1996, wealth (61%), caste/ethnicity (12%), mother's education (12%) and birth order (9%) were the major contributors to observed socioeconomic inequalities in stunting; while in 2016, wealth (72%), mother's BMI (12%) and birth order (9%) were the major contributors. CONCLUSIONS Despite remarkable improvements in average stunting over the last two decades, substantial socioeconomic inequalities in stunting exists and is determined not only by immediate factors but also by underlying and contextual factors which emphasize the need for coherent actions across different sectors. In addition to reducing inequalities in wealth, nutrition programming should be focused on most disadvantaged subgroups which are prone to both stunting and relative poverty.
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Affiliation(s)
| | | | - Kreepa Bhattarai
- Social Development and Promotion Centre, Sanepa, Lalitpur, Nepal
| | - Sumit Karn
- South Asian Infant Feeding Research Network – Nepal, Kathmandu, Nepal
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Na M, Aguayo VM, Arimond M, Narayan A, Stewart CP. Stagnating trends in complementary feeding practices in Bangladesh: An analysis of national surveys from 2004-2014. MATERNAL AND CHILD NUTRITION 2018; 14 Suppl 4:e12624. [PMID: 29999230 PMCID: PMC6586058 DOI: 10.1111/mcn.12624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/19/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022]
Abstract
Bangladesh has experienced steady socio‐economic development. However, improvements in child growth have not kept pace. It is important to document complementary feeding (CF) practices—a key determinant of children's growth—and their trends over time. The study aims to examine trends in CF practices in children aged 6–23 months using data from Bangladesh Demographic and Health Surveys conducted in 2004, 2007, 2011, and 2014. Multilevel logistic regression models were applied to identify independent predictors of four CF practice indicators among children 6–23 months, namely, timely introduction of complementary foods, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. Introduction of complementary foods was achieved among 64–71% of children between 2004 and 2014. The proportion meeting minimum meal frequency increased from 2004 to 2007 (71–81%) and declined and held steady at 65% from 2011 to 2014. The proportion meeting minimum dietary diversity in 2011 and 2014 was low (25% and 28%), and so was minimum acceptable diet (19% and 20%). From 2007 to 2014, child dietary diversity decreased and the most decline was in the consumption of legumes and nuts (29% to 8%), vitamin A‐rich fruits and vegetables (54% to 41%), and other fruits and vegetables (47% to 20%). Young child age (6–11 months), poor parental education, household poverty, and residence in the Chittagong and Sylhet independently predicted poorer feeding practices. Dietary diversity and overall diet in Bangladeshi children are strikingly poor. Stagnation or worsening of feeding practices in the past decade are concerning and call for decisive policy and programme action to address inappropriate child feeding practices.
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Affiliation(s)
- Muzi Na
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA.,Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, Pennsylvania, USA
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Mary Arimond
- Center for Dietary Intake Assessment, FHI 360, Washington, District of Columbia, USA
| | - Anuradha Narayan
- Nutrition Section, United Nations Children's Fund (UNICEF) Bangladesh Country Office, Dhaka, Bangladesh
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
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Cobalamin and Folate Status among Breastfed Infants in Bhaktapur, Nepal. Nutrients 2018; 10:nu10050639. [PMID: 29783689 PMCID: PMC5986518 DOI: 10.3390/nu10050639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
Cobalamin and folate are crucial micronutrients during infancy and they are required for growth and cognitive development. Due to the monotonous and predominantly vegetarian-based complementary feeding and poor maternal micronutrient status, infants from low- and middle-income countries are susceptible to cobalamin deficiency. However, data on plasma cobalamin and folate and the functional markers methylmalonic acid and total homocysteine from breastfed infants in Nepal are still needed. We collected plasma samples from 316 6–11-month-old breastfed infants with a length-for-age of less than minus one z-score and analyzed blood for plasma folate, cobalamin, methylmalonic acid and total homocysteine concentrations. Cobalamin deficiency (plasma cobalamin <148 pmol/L) was found among 11%, whereas 24% of the infants had plasma cobalamin concentrations between 148–221 pmol/L. Elevated total homocysteine (>10 µmol/L) and methylmalonic acid (>0.28 µmol/L) indicating functional cobalamin deficiency were found among 53% and 75% of the infants, respectively. Based on a combined indicator of cobalamin status, 58% were found to have low cobalamin status. However, folate deficiency (<10 nmol/L) was not found as the lowest value of plasma folate was 20.7 nmol/L. It is important to examine the extent to which poor cobalamin status during infancy has immediate or long-term consequences.
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32
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Na M, Aguayo VM, Arimond M, Dahal P, Lamichhane B, Pokharel R, Chitekwe S, Stewart CP. Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014. MATERNAL AND CHILD NUTRITION 2017; 14 Suppl 4:e12564. [PMID: 29148183 PMCID: PMC6586161 DOI: 10.1111/mcn.12564] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 12/30/2022]
Abstract
There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6–23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO‐UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community‐level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children.
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Affiliation(s)
- Muzi Na
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA.,Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, NY, USA
| | - Mary Arimond
- Center for Dietary Intake Assessment, FHI 360, Washington, DC, USA
| | - Pradiumna Dahal
- United Nations Children's Fund (UNICEF) Regional Office for South Asia, Kathmandu, Nepal
| | - Bikash Lamichhane
- Child Health Division, Government of Nepal Ministry of Health Department of Health Services, Kathmandu, Nepal
| | - Rajkumar Pokharel
- Child Health Division, Government of Nepal Ministry of Health Department of Health Services, Kathmandu, Nepal
| | - Stanley Chitekwe
- United Nations Children's Fund (UNICEF) Regional Office for South Asia, Kathmandu, Nepal
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA
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