Factors affecting feeding 6-23 months age children according to minimum acceptable diet in Ethiopia: A multilevel analysis of the Ethiopian Demographic Health Survey

Minimum acceptable diet and its predictors among children aged 6-23 months in Ethiopia. A multilevel cloglog regression analysis

Despite significant progress made previously and the recognized health benefits of optimal feeding practices, ensuring a minimum acceptable diet in developing countries like Ethiopia remains a formidable challenge. Additionally, there is a scarcity of data in this area. Therefore, our study aims to identify predictors of a minimum acceptable diet using a powerful tool called complementary log-log regression analysis. Thus, it contributes to accelerating the pathway of ending child undernutrition thereby promoting optimal child health. A multilevel analysis was conducted among a weighted sample of 1427 children aged 6-23 months using the 2019 Ethiopian Demographic Health Survey (EDHS). The EDHS sample was stratified and selected in two stages. A minimum acceptable diet is defined as a composite of children fed with both minimum dietary diversity and minimum meal frequency. Data extraction took place between August 1 and 30, 2023. We used STATA software version 17 for data analysis. A complementary log-log regression model was fitted to identify significant predictors of the minimum acceptable diet. A p-value of ≤0.05 was used to declare statistically significant predictors. Only 10.44% (95CI: 8.90-12.15) of the children meet the minimum acceptable diet. Child aged (18-23 month) (AOR = 1.78, 95CI:1.14-2.78)], mother's educational level (secondary and above education) (AOR = 279,95CI: 1.51-5.15), number of children three and above [(AOR = 0.78,95CI: 0.53-0.94], institutional delivery [AOR = 1.77,95CI: 1.11-3.11], having postnatal-check-up [AOR = 2.33,95CI: 1.59-3.41] and high community poverty level (AOR = 0.49,95CI: 0.29-0.85) were found to be predictors of minimum acceptable diet. In Ethiopia, only one in ten children achieve a minimum acceptable diet. Which is lower than the global report findings (16%). Enhancing maternal education programs and promoting family planning strategies to reduce household size are essential. Besides, encouraging institutional deliveries and postnatal check-ups are also recommended. It is necessary to implement targeted interventions for poverty reduction in communities to ensure that families can afford nutritious diets for their children.

Prevalence and predictors of minimum acceptable diet (MAD) feeding among tribal children aged 6-23 months in India

Minimum acceptable diet (MAD) that combines minimum dietary diversity (MDD) and minimum meal frequency (MMF) is one of the eight core indicators for assessing infant and young child feeding (IYCF) practices for children aged 6-23 months. With low MAD, young children and infants are more susceptible to undernutrition. The study assesses the prevalence and predictors of MAD among tribal children aged 6-23 months in India. Descriptive, bivariate, and multivariate analyzes were performed on data from 6326 tribal children of the National Family Health Survey (2019-21). Stata was used for the analyzes, with a 5% significance level. Only 12% of tribal children were fed with a MAD, while 24% had MDD and 34% MMF. Children aged 18-23 months had a three times higher chance of MAD than their 6-8 months counterparts. Children receiving Integrated Child Development Services (ICDS), children of mothers with ten or more years of schooling, children whose mothers were exposed to mass media, and whose mothers had 4+ antenatal care visits in their last pregnancy had a higher likelihood of MAD. The study concludes that MAD among tribal children aged 6-23 months is unsatisfactory and varies significantly by socio-demographic characteristics, suggesting targeted intervention.

Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis

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.

Household environment associated with anaemia among children aged 6-59 months in Ethiopia: a multilevel analysis of Ethiopia demographic and health survey (2005-2016)

BACKGROUND

Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia.

METHODS

In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6-59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05.

RESULTS

The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7-49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1-49.1) in 2005, 42.8% (95%CI: 41.8-43.8) in 2011, and increased to 57.4% (95%CI: 56.3-58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05-1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12-1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13-1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child's age (6-35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05-1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01-1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02-1.19), children from poor households (AOR: 1.18: 95%CI: 1.06-1.31), and rural residence (AOR: 1.23, 95%CI: 1.06-1.42).

CONCLUSION

In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies.

Minimum acceptable diet and associated factors among children aged 6-23 months in Jig-Jiga, Somali region, eastern Ethiopia, 2022

BACKGROUND

The minimum acceptable diet is the proportion of children aged 6-23 months who consumed the minimum meal frequency and minimum dietary diversity during the previous day or night. The minimum acceptable diet assesses both micronutrient adequacy and the quantity of food consumed during the previous day or night. Inappropriate infant and young child feeding practices during this period result in significant threats to child health through impaired cognitive development. Therefore, this study aims to assess the minimum acceptable diet and associated factors among children aged 6-23 months in Jig-Jiga, Somali region, Eastern Ethiopia.

METHODS

A community-based, cross-sectional study was conducted in Jig-Jiga town. A systematic random sampling technique was used to select 536 children aged 6-23 months with their mothers. Data were collected using a pre-tested, structured questionnaire. The data were entered into Epi-data 3.1. The data were cleaned and analyzed using SPSS v20. Bi-variable and multivariable logistic regression analyses were done, and model fitness was checked and tested by the Hosmer-Lemeshow goodness of fit test. The results of the adjusted odds ratio with 95% confidence intervals and P < 0.05 were considered statistically significant.

RESULT

The overall prevalence of a minimum acceptable diet was 47.2% (95% CI: 43.1-51.6). Occupation of fathers (AOR = 0.5, 95%CI: 0.3-0.8), child age of 6-11 months (AOR = 3.6, 95%CI: 1.7-7.7), age of the mother 15-24 years (AOR = 7.6, 95%CI: 1.5-38.146), 25-34 years (AOR = 5.56, 95%CI: 1.17-26.325), mothers who had only one under-five child (AOR = 2.1, 95%CI: 1.298-3.471), and media as a source of information (AOR = 0.16, 95%CI: 0.061-0.433) were associated with the minimum acceptable diet.

CONCLUSION

This study showed that the prevalence of a minimum acceptable diet was low. Factors associated with a minimum acceptable diet included the father's occupation, the child's age, the mother's age, having one under-five child, and the media as a source of information. Therefore, interventional strategies that focus on family planning and advocacy for infant and young child feeding are required to improve the provision of a minimum acceptable diet.

Prevalence and predictors of infant and young child feeding practices in sub-Saharan Africa

BACKGROUND

This study assessed the prevalence and predictors of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) in sub-Saharan Africa (SSA).

METHODS

A sample of 87 672 mother-child pairs from the 2010-2020 Demographic and Health Surveys of 32 countries in SSA was used. Multilevel binary logistic regression analysis was carried out to examine the predictors of MDD, MMF, and MAD. Percentages and adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings.

RESULTS

The prevalence of MDD, MMF, and MAD in SSA were 25.3% (95% CI 21.7 to 28.9), 41.2% (95% CI 38.8 to 43.6), and 13.3% (95% CI 11.6 to 15.0), respectively. Children aged 18-23 months were more likely to have MDD and MAD but less likely to have MMF. Children of mothers with higher education levels were more likely to have MDD, MMF, and MAD. Children who were delivered in a health facility were more likely to have MDD and MAD but less likely to have MMF.

CONCLUSIONS

Following the poor state of complementary feeding practices for infants and young children, the study recommends that regional and national policies on food and nutrition security and maternal and child nutrition and health should follow the internationally recommended guidelines in promoting, protecting, and supporting age-appropriate complementary foods and feeding practices for infants and young children.

Micronutrient intake status and associated factors in children aged 6-23 months in sub-Saharan Africa

Micronutrient deficiency has serious consequences across all ages worldwide, particularly in sub-Saharan Africa. Poor micronutrient (MN) consumption among children remains a major public health concern in many countries. Low literacy, poor diets, a lack of access to healthcare, and insufficient agricultural productivity made proper micronutrient consumption difficult, despite numerous interventions. Thus, this research aimed to determine the adequate intake of MNs among 6-23 months of age children in sub-Saharan Africa. Initially, a two-stage stratified sampling technique was applied for the selected recent demographic and health survey data. The data source was the (2015-2020) standard demographic and health surveys (DHS) among 20 Sub-Saharan African countries. Micronutrient intake status (the outcome variable) was determined using either food rich in Vitamin A or iron consumed within the previous 24 hr or multiple micronutrient powder or iron supplementation within the previous 07 days or vitamin A supplementation or deworming within 06 months. A generalized linear mixed model based on Modified Poisson regression and robust error variance was used to identify factors associated with children's adequate micronutrient intake. An adjusted Prevalence Ratio (aPR) with a 95% confidence interval was used to identify factors, strength and direction of the association. The total samples of 65,187 children aged 6-23 months were included. Of all, 73.99% (95% CI: 73.65, 74.32) of children had adequate intake of micronutrients. Maternal education (primary (aPR = 1.04, 95% CI: 1.02, 1.06) and secondary (aPR = 1.07, 95% CI: 1.04, 1.09)), father's education (primary (aPR = 1.03, 95% CI: 1.01, 1.05) and secondary (aPR = 1.04, 95% CI: 1.02, 1.06)), occupational status of the mother (aPR = 1.04, 95% CI: 1.02, 1.06), pregnancy interval (aPR = 0.97, 95% CI: 0.95, 0.99), exclusive breastfeeding status (aPR = 0.83, 95% CI: 0.82, 0.85), birthweight (average (aPR = 1.03, 95% CI: 1.01, 1.05) and larger than average (aPR = 1.04, 95% CI: 1.02, 1.06)), multiple/twin at birth (aPR = 0.94, 95% CI: 0.91, 0.98), child age (aPR = 1.22, 95% CI: 1.19, 1.25), number of children in home (aPR = 1.02, 95% CI: 1.01, 1.03), ANC utilization (aPR = 1.20, 95% CI: 1.15, 1.27), place of birth (AOR = 0.93, 95% CI: 0.91, 0.95), rich households (aPR = 1.03, 95% CI: 1.01, 1.05), and countries from Central (aPR = 1.07, 95% CI: 1.04, 1.09), South Africa (aPR = 1.07, 95% CI: 1.03, 1.11), and West African (aPR = 0.95, 95% CI: 0.92, 0.99) were associated with level of micronutrients intake status. The prevalence of adequate intake of MN was considerable. Variables at the child, family and community levels were associated with adequate intake of micronutrients. Consequently, stakeholders' involvement is required in healthcare and community settings.

Infant and young child feeding practices and associated socioeconomic and demographic factors among children aged 6-23 months in Ghana: Findings from Ghana Multiple Indicator Cluster Survey, 2017-2018

BACKGROUND

Association between poor infant and young child feeding (IYCF) practices and malnutrition in infants and young children (IYC) is well established. Furthermore, appropriate IYCF practices are important during the first 1,000 days of life to ensure optimal health and development. Understanding IYCF practices and associated socioeconomic and demographic factors will inform interventions to achieve the UN 2030 Sustainable Development Goal (SDG) target to end malnutrition in all forms.

OBJECTIVE

This study estimates the prevalence of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD), and examines their association with socioeconomic and demographic characteristics among children aged 6-23 months in Ghana.

METHOD

We used data from the Ghana Multiple Indicator Cluster Survey 6 (GMICS6) conducted in 2017-18. Participants were recruited through multi-stage stratified cluster sampling. Information on caregiver's self-reported breastfeeding status and 24-hour dietary recall of foods IYC were fed with were collected through face-to-face interviews. We estimated the prevalence of MDD, MMF and MAD with a 95% confidence interval (CI). We investigated the socioeconomic and demographic determinants of MDD, MMF and MAD using univariate and multivariable logistic regression analyses.

FINDINGS

Among 2,585 IYC aged 6-23 months, MDD, MMF and MAD were estimated as 25.46%, 32.82% and 11.72% respectively. Age of the IYC, educational status of the mothers/primary caregivers, and resident regions were found to have positive associations with MDD, MMF and MAD. In addition, the richest household wealth index and urban area of residence were found to have significant positive associations with MDD.

CONCLUSION

We report a low prevalence of MDD, MMF and MAD. Efforts to improve IYCF practices among children aged 6-23 months in Ghana should focus on multi-sectorial approaches including increasing access to formal education, income-generating activities and addressing regional and rural-urban inequity.

Determinants of meeting the minimum acceptable diet among children aged 6 to 23 months in Bangladesh: Evidence from a national representative cross-sectional study

Background

Minimum acceptable diet (MAD) is a core indicator of infant and child feeding practices (IYCF). Meeting the MAD is essential to enhance the nutritional status of children aged 6-23 months.

Objective

To identify the determinants of meeting the MAD among children aged 6-23 months in Bangladesh.

Methods

The study was based on a secondary dataset of the 2017-2018 Bangladesh Demographic and Health Survey (BDHS 2017-18). Complete (weighted) data from 2,426 children aged 6-23 months were analyzed.

Results

The overall percentage of meeting the MAD was 34.70%, whereas, in terms of urban and rural, it was 39.56% and 32.96%, respectively. Age of the children 9-11 months [Adjusted odds ratio (AOR) = 3.54; 95% CI: 2.33-5.4], 12-17 months [AOR = 6.72; 95% CI: 4.63-9.77], and 18-23 months [AOR = 7.12; 95% CI: 1.72-5.98], the maternal primary [AOR = 1.75; 95% CI: 1.07-2.86], secondary [AOR = 2.3; 95% CI: 1.36-3.89], and higher education [AOR = 3.21; 95% CI: 1.72-5.98], currently working mothers [AOR = 1.45; 95% CI: 1.13-1.79], mothers' access to mass media [AOR = 1.29; 95% CI: 1-1.66], and at least four antenatal care (ANC) from medically skilled providers [AOR = 1.74; 95% CI: 1.39,2.18] were independent determinants of meeting the MAD.

Conclusions

Many children are still far behind in meeting the MAD. Nutritional interventions like improved nutrition recipes, nutrition education and homemade food supplementation, nutritional counseling by home visits, community mobilization, health forums, antenatal and postnatal sessions, and media campaigns on IYCF are needed to meet MAD practice.

Impact of the Productive SafetyNet Program on the minimum acceptable diet in the rural community of South Gondar Zone, Northwest Ethiopia

Background

Even 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.

Methods

A 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.

Results

The 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.

Conclusion

In 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.

Minimum dietary diversity and associated factors among children aged 6-23 months in Enebsie Sar Midir Woreda, East Gojjam, North West Ethiopia

BACKGROUND

Dietary diversity has been recognized as a significant component of high-quality diets for children's growth and development. Poor infant and young child feeding practices in the first one thousand days of age is the major contributor of malnutrition that leads to failure to thrive to their age, in low-income countries including Ethiopia. It causes long-term consequences of chronic malnutrition, including as stunting, has an impact on intellectual development, and raises the risk of several infectious diseases and death. There was no research done on the dietary diversity of the children in the study area.

OBJECTIVE

The main objective of this study was to assess minimum dietary diversity and associated factors among children aged from 6-23 months in Enebsie Sar Midir Woreda.

METHODS

A community-based cross-sectional study design was used to assess the minimum dietary diversity and associated factors among children aged 6-23 months in Enebsie Sar Midir Woreda, East Gojjam, North West Ethiopia. A total of 512 Mothers/caregivers of children of 6-23 months old in the community were included in the study using a systemic sampling technique. Data were collected by the interviewer-administered structured, pre-tested questionnaire. A 24-hour recall method was used to capture the dietary intake of children during the previous 24 h period before the interview. The data were coded and entered into SPSS for windows version 20 and analyzed after cleaning. Descriptive statistics and bivariate and multivariable logistic regression models were used to isolate independent predictors of minimum dietary diversity. All tests were two-sided and P < 0.05 was used for declaring statistical significance.

RESULTS

The overall prevalence of minimum dietary diversity was 18.2% (CI: 14.8, 21.7). The dominant food groups consumed were roots, grains, and tubers. While consumption of vitamin A-rich fruits and vegetables and other vegetables were relatively low. On multivariable logistic regression model, after adjusting for other variables, availability of cow's milk at household (AOR = 17.27; 95% CI: 6.73, 44.44), cultivating vegetables (AOR = 3.2; 95% CI: 1.05, 9.8), availability of farmland (AOR= 10.15, 95%CI: 1.78, 57.93) and number of animals (AOR = 6.46; 95% CI: 1.97, 21.12) were significantly associated with minimum dietary diversity.  CONCLUSION: The proportion of infant and young children aged between 6-23months receiving minimum dietary diversity score is low compared with a study conducted in Addis Ababa. Availability of both animal and plant-source foods from household production was positively associated with practicing the minimum dietary diversity among children implying the need for strengthening nutrition-sensitive agricultural practices.

Change in stunting and its associated factors among children aged less than 5 years in Ethiopia using Ethiopia Demographic and Health Survey data from 2005 to 2019: a multivariate decomposition analysis

OBJECTIVE

The aim of this study is to assess change in stunting and its associated factors among children aged less than 5 years in Ethiopia using Ethiopia Demographic and Health Survey data from 2005 to 2019.

DESIGN

A community-based cross-sectional study was conducted.

SETTING

The study was conducted in Ethiopia.

PARTICIPANTS

In 2005, 4586 individuals were examined, followed by 10 282 in 2011, 9462 in 2016 and 4937 in 2019.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome of the study was stunting, and the secondary outcome was factors associated with stunting and its change. A multilevel logistic regression model was fitted to identify individual and community-level factors associated with stunting among children aged less than 5 years. Multivariate decomposition analysis was also carried out to assess the role of compositional characteristics and behavioural change for decline in stunting among children aged less than 5 years in Ethiopia.

RESULTS

Over the study period, the prevalence rate of stunting in children aged less than 5 years decreased from 47% to 37% in 2019. Differences in behavioural change among children under the age of 5 years account for 76.69% of the overall decline in stunting prevalence rate in the years 2005-2011, 86.53% in the years 2005-2016, 98.9% in the years 2005-2019, 70.34% in the years 2011-2016 and 73.77% in the years 2011-2019. Behavioural adjustments among breastfed children, diet diversity, place of delivery, ANC follow-up and region have all had a major effect on stunting prevalence rate. The wealth index, parenteral education, child's age in months, length of breast feeding and area were among the compositional change factors.

CONCLUSION

A large percentage of children aged less than 5 years remains stunted in Ethiopia. Stunting was associated with alterations in the compositional and behavioural characteristics of children. Stimulating existing nutritional measures and improving the wealth index will make a significant difference in reducing stunting among Ethiopian children aged less than 5 years.

Educational intervention and livestock ownership successfully improved the intake of animal source foods in 6-23 months old children in rural communities of Northern Ethiopia: Quasi-experimental study

Background

Animal source foods (ASFs) are rich in high-quality proteins, including essential amino acids and highly bioavailable micronutrients vital for child growth and cognitive development. But, the daily consumption of ASFs among 6–23 months old children is very low in Tigray, Northern Ethiopia.

Objective

The study aimed to assess the effectiveness of nutrition education intervention to improve the consumption of ASFs among 6–23 months old children from rural communities with strict religious fasting traditions of avoiding intake of ASFs in Northern Ethiopia.

Methods

A quasi-experimental study was conducted in two food insecure districts namely Samre Seharti (intervention) and Tanqua Abergele (comparison). The mother-child pairs in the intervention group (n = 140) received nutrition education based on the barriers and available resources for optimal consumption of ASFs among children and followed up for nine months. The mother-child pairs in the comparison group (n = 153) received routine nutrition education. The data were collected using a pre-tested structured questionnaire. The baseline and endline data assessment included interviews on socio-demographic and socio-economic status, dietary intake, and child feeding practices. The effectiveness of the intervention was measured using the difference-in-difference (DID) analysis model.

Results

At endline, the consumption of ASFs among children was 19.5 percentage points higher in the intervention group compared with the comparison group (p = 0.008). In addition, there was a significant increase in egg consumption among children in the intervention group (DID of 16.9, p = 0.012) from the comparison group. No child was consuming meat at baseline in both the intervention and comparison arms and it was very low at endline (5.2% vs. 7.9%). Overall, the proportion of children that consumed eggs in the intervention group was higher than in the comparison group in households that owned sheep and goats (4.8% vs. 21.4%, p = 0.050) and chicken (6.3% vs. 43.8%, p = 0.002) after education interventions. However, no statistically significant difference was observed between cow ownership and milk consumption among children (p>0.05).

Conclusions

Age-appropriate educational interventions for mothers and owning small livestock in the household can improve the consumption of ASFs and eventually the minimum diet diversity of children in communities with strict religious traditions of avoiding ASFs during the fasting seasons.

Anaemia and associated factors among children aged 6-23 months in agrarian community of Bale zone: a cross-sectional study

Anaemia remains among the most prevalent nutritional problems among children in developing countries. In Ethiopia, more than half of children <5 years of age are anaemic. In the early stages of life, it leads to poor cognitive performance, delay psychomotor development and decreases working capacity in later life. The present study aimed to assess the prevalence and associated factors of anaemia among children aged 6-23 months in the Bale zone. A community-based cross-sectional study was conducted from 1 to 30 June 2021. Multistage stratified sampling and simple random sampling techniques were employed to select 770 samples. An interviewer-administered questionnaire was used to collect data on socio-demographic, child health and feeding practices. Haemoglobin levels were estimated using a portable Hemosmart machine. Children with haemoglobin values below 11 g/dl were considered anaemic. Binary logistic regression analysis was performed to identify factors associated with anaemia. Statistical significance was set at P < 0⋅05. The prevalence of anaemia was 47⋅9 % (95 % CI (44⋅4, 51⋅5)). The multivariate analysis showed that child age (6-11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), household food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhoea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were significantly associated with anaemia. Anaemia in children aged 6-23 months was a severe public health problem in the study area. Integrated nutritional interventions combined with iron fortification and supplementation is recommended.

Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

Suboptimal feeding practices and impaired growth among children in largely food insecure areas of north Wollo, Ethiopia

In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6-23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6-8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9-11 months and 12-23 months, respectively). Overwhelmingly, none of the children (9-11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6-8 months and 12-23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6-8 months) and 51 % in older children aged 12-23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting.

Predictors of Minimum Acceptable Diet among Children Aged 6-23 Months in Nepal: A Multilevel Analysis of Nepal Multiple Indicator Cluster Survey 2019

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.

Spatial distribution of vitamin A rich foods intake and associated factors among children aged 6-23 months in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey

Background

Inadequate micronutrients in the diet and vitamin A deficiency are worldwide public health problems. In developing regions, many preschool children are undernourished, become blind every year and died before the age of 23 months. This study was aimed to explore the spatial distribution of vitamin A rich foods intake among children aged 6–23 months and identify associated factors in Ethiopia.

Methods

Ethiopian Mini Demographic and Health Survey 2019 dataset with a total 1407 children aged 6–23 months was used. Data management and processing were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for mapping and spatial visualization of the distribution. Spatial scan statistics was performed using SaTScan version 9.5 software for Bernoulli-based model. Multilevel mixed effect logistic regression model was employed to identify associated factors.

Results

Overall, 38.99% (95% CI: 36.46–41.62) of children aged 6– 23 months took vitamin A rich foods. Poor intake of vitamin A rich foods was significantly clustered Dire Dawa city, Somali and Harari regions of Ethiopia. Children aged 6–23 months lived in the primary cluster were 70% (RR = 1.70, P-value < 0.001) more likely to intake vitamin A rich foods than children lived outside the window. In the multilevel mixed effect logistic regression analysis, Primary educational status (AOR:1.42, 95% CI: 1.05, 1.93) and higher educational status (AOR:3.0, 95% CI: 1.59, 5.65) of mother, Dire Dawa (AOR:0.49, 95% CI: 0.22, 1.12) city, Afar (AOR: 0.16, 95% CI: 0.07, 0.36), Amhara (AOR: 0.37, 95% CI: 0.19, 0.71) and Somali (AOR: 0.02, 95% CI: 0.003, 0.08) regions of Ethiopia, children aged 13–23 months (AOR: 1.80, 95% CI: 1.28, 2.36), Mothers’ exposure to media (AOR: 1.41, 95% CI: 1.04, 1.92) were statistically significant factors for vitamin A rich foods intake among children aged 6–23 months.

Conclusions

Only 4 out of ten children took vitamin A rich foods which is too low compared to the national target and significantly clustered in Ethiopia. Mother’s educational status, Region, Child age and Mother’s media exposure are significant factors vitamin A rich foods intake. Stakeholders should strengthen mothers’ education status, creating awareness for mothers on child feeding and using locally available natural resource to produce vitamin A rich foods.

Minimum acceptable diet and associated factors among children aged 6-23 months during fasting days of orthodox Christian mothers in Gondar city, North West Ethiopia

Background

Nutritional improvement through appropriate feeding practices is critical for young children's healthy growth and development. Even if children are exempted from fasting, their diets are influenced by the widespread fasting practices of their Orthodox Christian mothers. However, scientific evidence on a minimum acceptable diet (MAD) among children aged 6–23 months during the fasting period was limited. Therefore, this study aimed to assess the minimum acceptable diet and associated factors among children aged 6–23 months during the fasting period among Orthodox Christian mothers in Gondar city, Northwest Ethiopia.

Method

A community-based cross-sectional study was conducted during the fasting season (Lent) from March 8, 20,121 to April 8, 2021. A total of 738 Orthodox Christian mothers with their children were selected by multistage sampling. A structured questionnaire was used to collect data among mothers to assess children’s MAD status. The degree of association between independent and dependent variables was assessed by using an odds ratio with a 95% confidence interval. Those variables with a p-value of less than 0.05 in the multivariable analysis were considered as a significant factor for MAD among children aged 6–23 months. Data were presented using texts, tables and figures.

Results

The overall prevalence of MAD among children aged 6–23 months was 19.4% (95% CI: 16.40%-22.20). Having household wealth index of rich and middle (AOR = 4.39, 95% CI: 2.26,8.50) and (AOR = 3.25, 95% CI: 1.69,6.22), respectively, children aged from 12–17 months (AOR = 2.66, 95% CI: 1.43,4.92) and 18–23 months (AOR = 5.39, 95% CI: 2.93,9.95) respectively, Children who lived with a family member who consumed any time without keeping the fasting time(AOR = 1.79, 95% CI: 1.13,2.83) and mothers of young children who were married (AOR = 4.13, 95% CI: 1.29,13.23) have significant association with MAD.

Conclusion

The practice of minimum acceptable diet was inadequate. Age of child, wealth status, marital status, and presence of family member who fed without keeping fasting time were significantly associated factors for MAD among children aged 6–23 months. Advocacy for appropriate feeding practice and meeting the MAD for children aged 6–23 months during the fasting period should also be strengthened targeting the unmarried women and those with poor households and giving awareness for mothers in collaboration with the respective religious leaders is highly recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00558-z.

Determinants of Inadequate Minimum Dietary Diversity Intake Among Children Aged 6-23 Months in Sub-Saharan Africa: Pooled Prevalence and Multilevel Analysis of Demographic and Health Survey in 33 Sub-Saharan African Countries

Background

Inappropriate feeding practices result in significant threats to child health by impaired cognitive development, compromised educational achievement, and low economic productivity, which becomes difficult to reverse later in life. There is minimal evidence that shows the burden and determining factors of inadequate dietary intake among children aged under 2 years in sub-Saharan African (SSA) countries. Therefore, this study aimed to assess the pooled magnitude, wealth-related inequalities, and other determinants of inadequate minimum dietary diversity (MDD) intake among children aged 6-23 months in the SSA countries using the recent 2010-2020 DHS data.

Methods

A total of 77,887 weighted samples from Demographic and Health Survey datasets of the SSA countries were used for this study. The Microsoft Excel and STATA version 16 software were used to clean, extract, and analyze the data. A multilevel binary logistic regression model was fitted. The concentration index and curve were applied to examine wealth-related inequalities in the outcomes. P-value < 0.05 with 95% CI was taken to declare statistical significance.

Results

The pooled magnitude of inadequate MDD intake among children aged 6-23 months in SSA was 76.53% (95% CI: 73.37, 79.70), ranging from 50.5% in South Africa to 94.40% in Burkina Faso. Individual-level factors such as women having secondary and above education (AOR = 0.66; 95% CI; 0.62, 0.70), being employed (AOR = 0.76; 95% CI; 0.72, 0.79), having household media exposure (AOR = 0.69; 95% CI; 0.66, 0.72), richest wealth (AOR = 0.46; 95% CI; 0.43, 0.50), having health institution delivery (AOR = 0.87;95% CI; 0.83, 0.91), and community-level factor such as living in upper middle-income country (AOR = 0.42; 95% CI; 0.38, 0.46) had a significant protective association, whereas rural residence (AOR = 1.29; 95% CI; 1.23, 1.36) has a significant positive association with inadequate MDD intake among children aged 6-23 months. Inadequate MDD intake among children aged 6-23 months in SSA was disproportionately concentrated on the poor households (pro-poor) (C = -0.24; 95% CI: -0.22, -0.0.26).

Conclusion and Recommendations

There is a high magnitude of inadequate minimum dietary diversity intake among children aged 6-23 months in SSA. Variables such as secondary and above maternal education, having an employed mother, having exposure to media, richest wealth, having health institution delivery, and living in the upper middle-income country have a significant negative association, whereas living in rural residence has a significant positive association with inadequate MDD intake. These findings highlight that to increase the MDD intake in the region, policy makers and other stakeholders need to give prior attention to enhancing household wealth status, empowering women, and media exposure.

Prevalence of drinking or eating more than usual and associated factors during childhood diarrhea in East Africa: a multilevel analysis of recent demographic and health survey

Background

Diarrhea is the second most common cause of death in under-five children. Fluid and food replacement during diarrheal episodes have a paramount effect to avert morbidity and mortality. However, there is limited information about feeding practices. This study aimed to assess the prevalence of drinking or eating more and associated factors during diarrhea among under-five children in East Africa using demographic and health surveys (DHSs).

Methods

Secondary data analysis was done on DHSs 2008 to 2018 in 12 East African Countries. Total weighted samples of 20,559 mothers with their under-five children were included. Data cleaning, coding, and analysis were performed using Stata 16. Multilevel binary logistic regression were performed to identify factors associated with drinking or eating more during diarrheal episodes. Adjusted Odds Ratio (AOR) with a 95% CI, and p-value < 0.05 were used to declare statistical significance.

Results

Prevalence of drinking or eating more than usual during diarrhea disease in East Africa was 26.27%(95% CI: 25.68–26.88). Mothers age > 35 years (AOR: 1.14, 95% CI: (1.03, 1.26), mothers primary education (AOR: 1.17, 95% CI: 1.06,1.28), secondary education (AOR: 1.43,95% CI: 1.27,1.61), and higher education (AOR: 1.42,95% CI: 1.11,1.81), occupation of mothers (agriculture, AOR: 2.2, 95% CI: 1.3–3.6), sales and services, AOR = 1.20, CI:1.07,1.34), manual, AOR =1.28,95% CI: 1.11,1.44), children age 1–2 years (AOR =1.34,95% CI: 1.22,1.46) and 3–4 years (AOR =1.36,95% CI: 1.20,1.55), four and more antenatal visits (AOR: 1.14,95% CI: 1.03,1.27), rich wealth status (AOR:1.27,95% CI: 1.16,1.40), birth in health facility (AOR = 1.19, 95%CI: 1.10, 1.30) and visit health facility (AOR = 1.12, 95%CI: 1.03, 1.22) were associated with drinking or eating more.

Conclusion

The prevalence of drinking or eating more is low in East Africa. Maternal age, occupation, antenatal care visit, marital status, educational status, wealth status, place of delivery, visiting health facility, and child age were significantly associated with drinking or eating more during diarrheal episodes. Health policy and programs should focus on educating mothers, improving the household wealth status, encouraging women to contact health facilities for better feeding practices of children during diarrheal episodes.

Trends and determinants of minimum acceptable diet intake among infant and young children aged 6-23 months in Ethiopia: a multilevel analysis of Ethiopian demographic and health survey

BACKGROUND

The minimum acceptable diet (MAD) has been used globally as one of the main indicators to assess the adequacy of feeding practices. More than half of the causes of under-five child mortality in developing countries including Ethiopia are attributed to malnutrition. With the exception of anecdotal information on the subject, progress overtime and how it influences the MAD has not been studied or well understood. Thus, this study aimed to determine the trends and determinants of MAD intake among infants and young children aged 6-23 months in Ethiopia.

METHODS

A community-based national survey dataset from the Ethiopian demographic and health survey (EDHS) 2019 were to identify predictors of MAD. In addition, the 2011, 2016, and 2019 EDHS data was used for trend analysis. The World Health Organization indicators were used to measure MAD. A weighted sample of 1457 infants and young children aged 6-23 months. A mixed-effects multi-level logistic regression model was employed using STATA version 16.0.

RESULTS

The proportions of infants and young children who received the MADs in Ethiopia were 4.1%, 7.3%, and 11.3% during the survey periods of 2011, 2016, and 2019, respectively. Having mothers who attended primary education [adjusted odds ratio (aOR) =2.33 (95% C.I 1.25 to 4.35)], secondary education [aOR = 2.49 (95% C.I 1.03 to 6.45)], or higher education [aOR = 4.02 (95% C.I 1.53 to 10.54)] compared to those who never attended formal education. Being in a medium househoold wealth [aOR = 4.06 (95% C.I 1.41 to 11.72)], higher-level wealth [aOR = 4.91 (95% C.I 1.49 to 16.13)] compared to those in the lowest househoold wealth. Being in 12-18 months age group [aOR = 2.12 (95% C.I 1.25 to 3.58)] and in 18-23 months age category [aOR = 2.23 (1.29 to 3.82)] compared to 6-11 months age group; and having postnatal check-ups [aOR = 2.16 (95% C.I 1.31 to 3.55)] compared to their counterparts. Moreover, residing in urban [aOR = 3.40 (95% C.I 1.73 to 6.68)]; living in a communities' where majority had a media exposure [aOR 1.80 (95% C.1.17 to 2.77)] were found to be significantly influenc consumption of the MAD.

CONCLUSIONS

The trends of MAD among children of 6-23 months was steady in Ethiopia. Sociodemographic and socioeconomic factors such as maternal education, child age, household wealth; and health system related factors such as maternal postnatal check-ups had a significant influence on infants' and young children's MAD feeding. Indeed, commnity-level factors such as place of residence, and media exposure affect the MAD of infants and young children. Thus, behavioral change communication interventions are recommended to improve dietary practices in infants and young children.

Minimum acceptable diet feeding practice and associated factors among children aged 6-23 months in east Africa: a multilevel binary logistic regression analysis of 2008-2018 demographic health survey data

BACKGROUND

Despite the proportion of receiving a minimum acceptable diet (minimum meal frequency and minimum dietary diversity) is lower in east Africa, there is limited evidence on minimum acceptable diet. Therefore, this study aimed to investigate the minimum acceptable diet and associated factors among children aged 6-23 months in east Africa.

METHODS

A secondary data analysis of the most recent Demographic and Health Survey (DHS) data of 12 east African countries was done. A total weighted sample of 34, 097 children aged 6-23 months were included. A multilevel binary logistic regression model was applied. The Intra-class Correlation Coefficient (ICC) and Median Odds Ratio (MOR) were calculated to assess the clustering effect. Besides, deviance was used for model comparison as the models are nested models. Both crude and adjusted Odds Ratio (OR) with a 95% Confidence Interval (CI) were reported as potential predictors of minimum acceptable diet feeding practice.

RESULTS

The prevalence of minimum acceptable diet feeding practice among children in east Africa was 11.56%; [95%CI; 11.22%, 11.90%]. In the multilevel analysis; child age of 12-17 month (AOR = 1.33: 95%CI; 1.20, 1.48), maternal primary (AOR = 1.21: 95%CI; 1.08, 1.35), secondary (AOR = 1.63: 95%CI; 1.44, 1.86) higher (AOR = 2.97: 95%CI; 2.30, 3.38) education level, media exposure (AOR = 1.38, 95%CI; 1.26, 1.51), household wealth statues (AOR = 1.28, 95%CI; 1.15, 1.42 for middle and AOR = 1.50: 95%CI; 1.42, 1.71 foe rich), employed mother (AOR = 1.27: 95%CI; 1.17, 1.37), maternal age 25-34 (AOR = 1.20: 95%CI; 1.09, 1.32) and 35-49 (AOR = 1.22: 95%; 1.06, 1.40) years, delivery in health facility (AOR = 1.43: 95%CI; 1.29, 1.59) and high community education level (AOR = 1.05: 95%CI; 1.01, 1.17) were positively associated with minimum acceptable diet child feeding practice. Meanwhile, the use of wood (AOR = 0.72: 95%CI; 0.61, 0.86) and animal dug (AOR = 0.34: 95%CI; 0.12, 0.95) as a source of cooking fuel and being from female-headed households (AOR = 0.88: 95%CI; 0.81, 0.96) were negatively associated with minimum acceptable diet feeding practice.

CONCLUSION

Child age, mother's educational level, source of cooking fuel, exposure to media, sex of household head, household wealth status, mother working status, age of the mother, place of delivery and community-level education were the significant determinants of minimum acceptable diet feeding practices. Therefore, designing public health interventions targeting higher-risk children such as those from the poorest household and strengthening mothers' education on acceptable child feed practices are recommended.

Does socioeconomic inequality exist in minimum acceptable diet intake among children aged 6-23 months in sub-Saharan Africa? Evidence from 33 sub-Saharan African countries' demographic and health surveys from 2010 to 2020

Background

Child undernutrition is a major public health problem in many resource-poor communities in the world. More than two-thirds of malnutrition-related child deaths are associated with inappropriate feeding practices during the first 2 years of life. Socioeconomic inequalities are one of the most immediate determinants. Though sub-Saharan Africa (SSA) shares the huge burden of children undernutrition, as to our search of literature there is limited evidence on the pooled magnitude, socioeconomic inequalities of minimum acceptable diet intake and its contributing factors among children aged 6 to 23 months in the region. This study aimed to assess the level of socio-economic inequalities of minimum acceptable diet intake, and its contributor factors among children aged 6–23 months in SSA using recent 2010–2020 DHS data.

Methods

A total of 78,542 weighted samples from Demographic and Health Survey datasets of SSA countries were used for this study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. The concentration index and curve and wag staff type decomposition analysis were applied to examine wealth-related inequalities in the outcomes. P-value < 0.05 was taken to declare statistical significance.

Results

The pooled magnitude of MAD intake among children age 6–23 months in SSA was 9.89% [95%CI: 8.57, 11.21%] ranging from 3.10% in Guinea to 20.40% in Kenya. MAD intake in SSA was disproportionately concentrated on the rich households (pro-rich) [C = 0.191; 95% CI: 0.189, 0.193]. Residence (36.17%), media exposure (23.93%), and women’s education (11.63%) explained the pro-rich inequalities in MAD intake. The model explained 55.55% of the estimated socioeconomic inequality in MAD intake in SSA.

Conclusion and recommendations

Minimum acceptable diet intake in SSA is relatively low. There are moderate socioeconomic inequalities in MAD intake in SSA, mainly explained by residence, media exposure and women’s education. The government of sub-Saharan African countries should plan and work in short terms through the program that endorses women empowerment such as income generation, cash assistance for mothers who have under 2 years of children and women employment using affirmative actions, and nutrition education such as media campaigns and promoting breast feedings. Long-term plans are also needed for those SSA countries with lower income status through programs to enhance their country’s economy to the middle and higher economic level and to improve the wealth index of individual households to narrow the poor-rich gap in the minimum acceptable diet intake.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00521-y.

Minimum acceptable diet intake and its associated factors among children age at 6-23 months in sub-Saharan Africa: a multilevel analysis of the sub-Saharan Africa demographic and health survey

Background

Only one in five children aged below 24 months in the low-income countries feed the minimum recommended diet, and significantly varied across socio-economic classes. Though sub-saharan Africa (SSA) shares the huge burden of children under nutrition, as to our search of literature there is limited evidence on the pooled magnitude and factors associated with minimum acceptable diet (MAD) intake among children aged 6 to 23 months in the region. This study aimed to assess the pooled magnitude and associated factors of MAD intake among children aged 6–23 months in SSA using recent 2010–2020 DHS data.

Methods

Demographic and Health Survey datasets of SSA countries were used for this study with a total of 78,542 weighted samples. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. The adjusted odds ratio (AOR) with P-value < 0.05 was taken to declare statistical significance.

Results

The pooled magnitude of MAD intake among children aged 6–23 months in SSA was 9.89% [95%CI: 8.57, 11.21%] ranging from 3.10% in Guinea to 20.40% in Kenya. Individual level factors such as; secondary &above women educational status [AOR = 1.41; 95%CI; 1.29, 1.53], having employed women [AOR = 1.25;95%CI;1.17,1.33], having media exposure [AOR = 1.55;95%CI;1.45,1.66], richest household wealth [AOR = 1.93; 95%CI; 1.73, 2.15], plural birth [AOR = 0.68;95%CI; 0.56, 0.82] and breastfed child [AOR = 2.04; 95%CI; 1.89, 2.21], whereas, community level factor such as rural residence [AOR = 0.74; 95%CI; 0.69, 0.79] and living in upper middle income country [AOR = 1.62; [95%CI; 1.41,1.87] were significantly associated with MAD intake.

Conclusion and recommendations

Minimum acceptable diet intake in SSA is relatively low. Variables such as; secondary &above maternal education, having employed mother, exposure to media, richest wealth, breast feeding child, and upper middle income country have a significant positive association, whereas having plural birth and living in rural residence have a significant negative association with MAD intake. These findings highlight that policymakers and other stakeholders had better give prior attention to empowering women, enhance household wealth status and media exposure to increase the MAD intake in the region.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12966-8.

Spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia: spatial and multi-level analysis based on 2016 EDHS

Background

Bottle feeding is associated with diarrheal disease morbidity and mortality and risk of pyloric stenosis, especially in developing countries. Even though, World Health Organization (WHO) recommended avoiding bottle feeding among children, still higher magnitude was reported in developing countries. This study aimed to assess the spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia.

Methods

This study was conducted based on Ethiopian Demographic and Health Surveys data (EDHS). The data were weighted using sampling weight for probability sampling and non-response to restore the representativeness of the data and get valid statistical estimates. Then a total of 4,275 weighted samples of under two years children were used to investigate the study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. P-value < 0.05 was taken to declare statistical significance. A spatial analysis was done using ArcGIS and SaTScan software.

Results

The prevalence of bottle feeding practice among under two years children in Ethiopia were 13.5% (95%CI: 11.16, 15.29) and ranges from the lowest 5.16% (95% CI: 3.28, 78.73) Amhara region to the highest 55.98% (95% CI: 47.98, 61.46) Addis Ababa region. Women with secondary and above education status [AOR=2.49; 95%CI; 1.66, 3.74], women from richest household [AOR=1.33; 95%CI; 1.01, 1.78], child 12-23 months age [AOR= 1.59; 95%CI; 1.23, 2.05], multiple birth [AOR=4.30; 95%CI; 1.88, 9.84], rural residence [AOR=0.49; 95%CI; 0.16, 0.82] and large central region [AOR= 0.15; 95%CI; 0.08, 0.27] have significantly associated with bottle feeding. Addis Ababa, Central Oromia, Dire Dewa, Somali and Harari regions were the hot spot areas for bottle feeding practice among under two years children.

Conclusion and recommendations

The prevalence of bottle feeding practices in Ethiopia is relatively moderate. Maternal education, wealth index, child age, multiple births, residence and region were significant predictors of bottle feeding. These findings highlight that, the Ministry of Health Ethiopia (MOH), policymakers, and other stakeholders had better give prior attention to preventable factors such as empowering women, enhancing household wealth status to decreasing bottle feeding practice in Ethiopia.

The influence of fasting on energy and nutrient intake and their corresponding food sources among 6-23 months old children in rural communities with high burden of stunting from Northern Ethiopia

BACKGROUND

Limited studies in Ethiopia showed that infants and young children are at high risk of inadequate intake of energy and nutrients. However, inclusive assessment of both nutrient intakes and their food sources are lacking. We aimed at assessing energy and nutrient intakes and their food sources during religious fasting and non-fasting periods among 6-23 months old children in Northern Ethiopia.

METHODS

Data for this longitudinal study were collected following repeated multiple-pass 24-h dietary recall technique through face-to-face interviews with primary caregivers. Using a two-stage systematic random sampling method, a total of 570 and 551 children participated respectively in the lent fasting and non-fasting periods. Energy and nutrient intakes were estimated and compared with WHO daily requirements. All foods that a child consumed on the day preceding the date of data collection were recorded and processed with database software. Chi-square and t- tests were used to analyze the data. Non-normally distributed data were analyzed using Wilcoxon signed-rank test and statistical significance was set at p < 0.05.

RESULTS

The overall prevalence of child stunting was 41.4%. Almost all of children (99.6%) consumed grains, roots, and tubers. The inadequacy prevalence of energy, protein and eight selected micronutrients (calcium, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C) intake were 96.2, 44.9, and 95.5%, respectively. Calcium and zinc were the highest (100%) deficits observed across all age groups. Although consumption of animal source foods (ASFs) was very low (dairy 10.1%, meat 2.3% and eggs 23.6%), there was significantly higher consumption of meat and eggs during the non-fasting compared to fasting period (p < 0.001).

CONCLUSIONS

Inadequate intake of energy and nutrients was common among 6-23 months old children. Cereals were found to be the main sources of many of the nutrients. The consumption of ASFs among 6-23-month-old children was low which was also affected by the religious fasting period. Hence, strengthening social and behavior change communication, supporting rural households to raise poultry and small ruminants is recommended.

Factors Associated with Minimum Acceptable Diet in 6–11-Month-Old Indonesian Children Using the 2017 IDHS

BACKGROUND: Inadequate complementary feeding practices are known to contribute to children’s nutritional status. A minimum acceptable diet (MAD) is one of the simple, valid, and reliable indicators to assess complementary feeding practices in 6–23-month-old children on food diversity and meal frequency. Based on the UNICEF data, the MAD of 6–11 months in Indonesia was 26.3% in 2017 and the lowest compared to other groups. Hence, this study research question is posing toward several factors associated with the low MAD among 6–11 months infant. AIM: This study aimed to determine factors associated with MAD in 6–11-month-old children in Indonesia. METHODS: This study was a secondary analysis using the 2017 Indonesia Demographic and Health Survey. This is a cross-sectional study involving 17,848 children in Indonesia. Final sample to be analyzed were 1,441 children of 6–11-month-old. Logistic regression model was applied to identify the significant risk factors associated with MAD. RESULTS: The result showed that the prevalence of MAD in this study is 29%. From the multivariate logistic regression, wealth index, television ownership, and mother’s occupation were significantly associated with MAD of 6–11-month-old children in Indonesia. CONCLUSION: In conclusion, factors associated with MAD among 6–11-month-old children were wealth index, television ownership, and mother’s occupation.

Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia

INTRODUCTION

The health and growth of children less than two years of age can be affected by the poor quality of complementary foods and poor feeding practices even with optimal breastfeeding. In Ethiopia, empirical evidence on the minimum acceptable diet and its associated factors is limited. Therefore, this study was aimed to assess the level of minimum acceptable diet and its associated factors among children aged 6-23 months in Addis Ababa Ethiopia.

METHODS

An institution-based Cross-sectional study was conducted among a total of 575 mother-child pairs. A simple random sampling technique was used to recruit participants. For infant and young child feeding practices, the data collection tools were adapted from world health organizations' standardized questionnaire which is developed in 2007. Data entry and analysis were performed using EPI data version 3.1 and SPSS version 20 respectively. Bivariable and multivariable logistic regression analyses were performed to determine predictor variables. Statistical significance was declared at p-value < 0.05.

RESULT

In this study, the level of minimum acceptable diet was found to be 74.6%.. About 90.6 and 80.2% of the children received minimum meal frequency and dietary diversity respectively. Having a husband secondary and above educational level [AOR = 4.789(95%CI:1.917-11.967)], being a housewife [AOR = 0.351(95% CI: 0.150-0.819)], having a history of more than three postnatal follow-ups [AOR = 2.616(95%CI:1.120-6.111], Having mothers age between 25 and 34 years [AOR = 2.051(95%CI:1.267-3.320)], being male child [AOR = 1.585(95%CI:1.052-2.388)] and having children age between 18 and 23 months [AOR = 3.026(95%CI:1.786-5.128)] were some of the factors significantly associated with a minimum acceptable diet.

CONCLUSION

In this study, the minimum acceptable diet among children aged 6-23 months was significantly associated with the educational status of the husband, mother's occupation, history of postnatal follow-up, age of the mother, sex of the child, and age of the child. Thus, attention should be given to educating the father, empowering mothers to have a job, promoting gender equality of feeding, and counseling on the benefit of postnatal care visits. In addition, the ministry of health should work on educating and advocating the benefit of feeding the recommended minimum acceptable diet to break the intergenerational cycle of malnutrition.

Micronutrient intake status and associated factors among children aged 6-23 months in the emerging regions of Ethiopia: A multilevel analysis of the 2016 Ethiopia demographic and health survey

BACKGROUND

Micronutrient (MN) deficiency among children is recognised as a major public health problem in Ethiopia. The scarcity of MNs in Ethiopia, particularly in pastoral communities, might be severe due to poor diets mitigated by poor healthcare access, drought, and poverty. To reduce MNs deficiency, foods rich in vitamin A (VA) and iron were promoted and programs like multiple micronutrient powder (MNP), iron and vitamin A supplements (VAS) and or deworming have been implemented. Nationally for children aged 6-23 months, consumption of four or more food groups from diet rich in iron and VA within the previous 24 hours, MNP and iron supplementation within seven days, and VAS and >75% of deworming within the last 6 months is recommend; however, empirical evidence is scarce. Therefore, this study aimed to assess the recommended MN intake status of children aged 6-23 months in the emerging regions of Ethiopia.

METHODS

Data from the Ethiopia Demographic and Health Survey 2016 were used. A two-stage stratified sampling technique was used to identify 1009 children aged 6-23 months. MN intake status was assessed using six options: food rich in VA or iron consumed within the previous 24 hours, MNP or iron supplementation with the previous seven days, VAS or deworming within six months. A multilevel mixed-effect logistic regression analysis was computed, and a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to identify the individual and community-level factors.

RESULTS

In this analysis, 37.3% (95% CI: 34.3-40.3) of children aged 6-23 months had not received any to the recommended MNs sources. The recommended MNs resulted; VAS (47.2%), iron supplementation (6.0%), diet rich in VA (27.7%), diet rich in iron (15.6%), MNP (7.5%), and deworming (7.1%). Antenatal care visit (AOR: 1.9, 95% CI: 1.4-2.8), work in the agriculture (AOR: 2.2, 95% CI: 1.3-3.8) and children aged 13 to 23 months (AOR: 1.7, 95% CI: 1.2-2.4) were the individual-level factors and also Benishangul (AOR: 2.2, 95% CI: 1.3-4.9) and Gambella regions (AOR: 1.9, 95% CI: 1.0-3.4) were the community-level factors that increased micronutrient intake whereas residence in rural (AOR: 0.4, 95% CI: 0.1-0.9) was the community-level factors that decrease micronutrient intake.

CONCLUSIONS

Micronutrient intake among children aged 6-23 months in the pastoral community was low when compared to the national recommendation. After adjusting for individual and community level factors, women's occupational status, child's age, antenatal visits for recent pregnancy, residence and region were significantly associated with the MN intake status among children aged 6-23 months.

The role of complementary feeding in India's high child malnutrition rates: findings from a comprehensive analysis of NFHS IV (2015-2016) data

Relative to its economic growth and poverty levels, Indian children suffer from higher levels of malnutrition than children in many other low- and middle-income countries. Research presented in this article examined the links between infant and young child feeding practices among Indian children and their rates of stunting, underweight, wasting, and anaemia, with a particular focus on the types of semisolid complementary food consumed. It did so through a comprehensive analysis of data on more than 57,000 6-to-23-month-old children obtained from the nationally representative National Family Health Survey IV (2015–2016). One of the key findings was that especially feeding children animal-sourced and vitamin-A-rich food was associated with lower malnutrition rates. The study further interrogated whether livestock ownership and participation in the Integrated Child Development Services programme could be supportive of better complementary child feeding and concluded that daily food receipts from the programme and poultry ownership were indeed linked with significantly higher rates of children following the recommended feeding practices as well as with somewhat lower children’s malnutrition rates.

Minimum acceptable diet practice and its associated factors among children aged 6-23 months in rural communities of Goncha district, north West Ethiopia

BACKGROUND

After the first 6 months breast milk is no longer sufficient to meet the nutritional needs of the infant. Therefore, complementary foods should be added to the child's diet. Feeding children with a diversified diet is practiced improperly in developing countries including Ethiopia particularly in the rural community of the Amhara region. However, limited information was documented on the rural communities and no data were available specifically in the study area to show the exact picture of child feeding practices. So, this study was planned to assess minimum acceptable diet practice and its associated factors among children aged 6-23 months in the rural community of Goncha district, Amhara region, Ethiopia.

METHODS

Community-based cross-sectional study was employed to determine minimum acceptable diet practice and its associated factors among children aged 6-23 months at rural communities of Goncha district, East Gojjam zone, Amhara region, Ethiopia. A multi-stage sampling technique was used to select study subjects, and an interview administered structured questionnaire was used to collect the data. Data were entered by Epi Data version 4.0.2 and exported to SPSS 20 for analysis. Bivariate and multivariable logistic regression analysis was used to see the association. Then, P-value < 0.05 with 95% CI on multivariable logistic regression analysis were used to identify the predictor of the outcome variable.

RESULTS

A total of 430 mothers who have children aged 6-23 months were included in the analysis with a 98% of response rate. About 12.6% of children aged 6-23 months received the recommended minimum acceptable diet. Children whose mothers who had formal education [AOR = 2.7, 95%CI (1.133, 6.231)], institutional delivery [AOR = 4.5, 95%CI (1.986, 10.362)], media exposure [AOR = 2.6, 95%CI (1.303, 5.291)] and higher household wealth index [AOR = 2.5, 95%CI (1.139, 5.90)] were significantly associated with minimum acceptable diet.

CONCLUSION

The practice of minimum acceptable diet in the study area was inadequate and very low according to the national recommendation. So, strengthening institutional delivery, improving the wealth of the community and exposure to media, and finally empowering women's' for education is recommended.

Determinants of minimum acceptable diet feeding among children aged 6-23 months in Odisha, India

OBJECTIVE

To assess the level, pattern and determinants of minimum acceptable diet (MAD) feeding in Odisha, India.

DESIGN

Utilising cross-sectional data, the MAD was estimated through a dietary assessment method wherein the child's mother was asked to recall all the food intake of the youngest child the previous day and night of the surveyed date.

SETTING

National Family Health Survey 2015-2016.

PARTICIPANTS

Children aged 6-23 months, living with mother and for whom complete information on MAD was available (n 3073).

RESULTS

Only 8·4 % of the children aged 6-23 months were fed MAD, and the MAD feeding varies considerably by socio-demographic characteristics. Children aged 12-17 months had two times (OR: 2·51, 95 % CI (1·48, 4·26)) and those aged 18-23 months had three times (OR: 3·77, 95 % CI (2·25, 6·30)) higher odds of having a MAD than their counterparts aged 6-8 months. Children whose mother was exposed to any mass media had a higher chance of MAD feeding (OR: 1·46, 95 % CI (1·01, 2·11)).

CONCLUSIONS

The children of higher age, second or higher-order births, with mother exposed to mass media are significantly more likely to be fed with a MAD. At the same time, children from scheduled caste (SC) households have a lower probability of MAD feeding. The lower MAD feeding among the SC households suggests strengthening the ongoing programmes with a higher emphasis on the inclusion of this disadvantaged and marginalised group. Findings from the current study would assist policymakers, and public health managers improve MAD feeding practices in Odisha, India, in a targeted manner.

Minimum acceptable diet and associated factors among infants and young children aged 6-23 months in Amhara region, Central Ethiopia: community-based cross-sectional study

OBJECTIVE

The main objective of this study was to assess the prevalence of a minimum acceptable diet (MAD) and associated factors.

DESIGN

Community-based cross-sectional study SETTING: Debre Berhan Town, Ethiopia.

PARTICIPANTS

An aggregate of 531 infants and young children mother/caregiver pairs participated in this study. A one-stage cluster sampling method was used to select study participants and clusters were selected using a lottery method. Descriptive statistics were calculated for all study variables. Statistical analysis was performed on data to determine which variables are associated with MAD and the results of the adjusted OR with 95% CI. P value of <0.05 considered statistically significant.

PRIMARY OUTCOME

Prevalence of MAD and associated factors RESULTS: The overall prevalence of MAD was 31.6% (95% CI: 27.7 to 35.2). Having mother attending secondary (adjusted OR, AOR=4.9, 95% CI: 1.3 to 18.9) and college education (AOR=6.4, 95% CI: 1.5 to 26.6), paternal primary education (AOR=1.3, 95% CI: 1.5 to 2.4), grouped in the aged group of 12-17 months (AOR=1.8, 95% CI: (1.0 to 3.4) and 18-23 months (AOR=2.2, 95% CI: 1.2 to 3.9), having four antenatal care (ANC) visits (AOR=2.0, 95% CI: 1.0 to 3.9), utilising growth monitoring (AOR=1.8, 95% CI: 1.1 to 2.9), no history of illness 2 weeks before the survey (AOR=2.9, 95% CI: 1.5 to 6.0) and living in the household with home garden (AOR=2.5, 95% CI: 1.5 to 4.3) were positively associated with increase the odds of MAD.

CONCLUSION

Generally, the result of this study showed that the prevalence of minimum acceptable was very low. Parent educational status, ANC visits, infant and young child feeding advice, child growth monitoring practice, age of a child, a child has no history of illness 2 weeks before the survey, and home gardening practice were the predictors of MAD. Therefore, comprehensive intervention strategies suitable to the local context are required to improve the provision of MAD.

Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005-2016

Background

Anemia has severe public health significance in sub-Saharan Africa. In Ethiopia, anemia has been increasing in the last two decades, reaching the highest national level in 2016, however, the geospatial distribution and determinants of anemia in children weren’t well explored at a national level.

Methods

We used the Ethiopian Demographic and Health Survey(EDHS) data from 2005–2016. The data consists of samples of households (HHs) obtained through a two-stage stratified sampling procedure. Our analysis included 19,699 children. Descriptive statistics, geospatial analysis, and Generalized Linear Mixed Model (GLMMs) were used.

Results

The overall prevalence of anemia was 51.5%; the spatial distribution of anemia significantly different across clusters in each survey. Children from 6 to 11 months had higher odds of anemia compared to 24–59 months (Adjusted Odds ratio (AOR) = 3.4, 95%Confidence level (CI): 2.99–3.76). Children with the first and second birth order were less likely to be anemic compared to fifth and above (AOR = 0.60, 95%CI: 0.38–0.95, and AOR = 0.83, 95%C: 0.73–0.93) respectively. Mothers’ age 15 to 24 years was associated with higher odds of anemia compared to 35 to 49 years (AOR = 1.37, 95%CI: 1.20–1.55). Children from HHs with the poorest and poorer wealth category showed a higher odds of anemia compared to the richest (AOR = 1.67, 95%CI: 1.45–1.93, and AOR = 1.25, 95%CI: 1.08–1.45) respectively. Moreover, children from HHs with one to two under-five children were less likely to be anemic compared to those three and more (AOR = 0.83, 95%CI: 0.76–0.91).

Conclusions

The geospatial distribution of anemia among children varies in Ethiopia; it was highest in the East, Northeast, and Western regions of the country. Several factors were associated with anemia; therefore, interventions targeting the hotspots areas and specific determinant factors should be implemented by the concerned bodies to reduce the consequences of anemia on the generation.

Infant and young child feeding practices in Ethiopia: analysis of socioeconomic disparities based on nationally representative data

BACKGROUND

Undernutrition among children is a priority area of public health concern in Ethiopia. The purpose of this study was to examine disparities in Infant and Young Child Feeding (IYCF) practices among children 6-23 months.

METHOD

Data were drawn from the 2016 Ethiopian Demographic and Health Surveys (EDHS). A total of 3240 children aged 6-23 months were used for the present analysis. The outcome variable was IYCF practice score (ranging 0-7) which was constructed based on the linear and combined effects of four sets of variables: breastfeeding, avoidance of bottle feeding, diet diversity score and minimum feeding frequency. IYCF practice score was further recoded into three categories. Proportional odds regression was used to assess the determinants of IYCF category.

RESULTS

The proportional odds regression analysis showed that IYCF scores significantly decreased by 5% (Adjusted Odds Ratio (AOR) = 0.95; 95% CI: 0.93-0.97) for every unit increase in the child's age. Households with fathers of primary and secondary and above level education were 1.37 times (95% CI: 1.14-1.66) and 1.67 times (95% CI: 1.26-2.23) more likely to be in the high IYCF category than in the poor IYCF category. The likelihood of being in the high IYCF practice category decreased for non-working mothers by 30% (AOR = 0.70; 95% CI: 0.59-0.83) compared to those working in gainful employment. The chance of being in the high IYCF practice category decreased by 29% for households with no access to radio (AOR = 0.71; 95% CI: 0.59-0.85). Those with medium and rich/richer wealth category were 1.54 times (95% CI: 1.22-1.94) and 1.40 times (95% CI: 1.11-1.75) more likely to belong to high IYCF practice category than being in poor IYCF category. For every unit increase in health service utilization, the chance of falling in higher IYCF category increases by 1.15 times (95% CI: 1.08-1.23). The chance of falling in higher IYCF practice category decreases for rural residents by 37% (AOR = 0.63; 95% CI: 0.47-0.84) compared to those residing in urban areas.

CONCLUSION

For a child, the first two years is the time span during which linear faltering of growth is most prevalent and the period when the process of becoming stunted is almost complete. This study recommends improving access to women for gainful employment, provision of economic support to poor rural women, education and promotion of nutrition messages using most accessible media and boosting the positive role of fathers in child feeding practices.

Feeding Practices and Associated Factors During Diarrheal Disease Among Children Aged Less Than Five Years: Evidence from the Ethiopian Demographic and Health Survey 2016

Purpose

Diarrhea is a common childhood illness and one of the leading causes of death in young children globally. In Ethiopia, a significant number of deaths and hospitalizations in under-five children are related to diarrheal diseases. Inappropriate feeding during diarrhea leads to a double burden of diarrhea recurrence and malnutrition among children. However, empirical evidence is limited in Ethiopia. Thus, this study was aimed to assess feeding practices and associated factors during diarrheal disease among children aged less than five years in Ethiopia.

Patients and Methods

The study used the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A two-stage stratified sampling technique was applied to identify 917 under five years children. Generalized linear mixed model analyses were computed, and a P value of less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to identify statistically significant factors with feeding practices.

Results

The majority (92.5%) of mothers were married. Out of the participants, (54.1%) of children were male; 55.6% of them were in the age group of 6–23 months. The appropriate feeding practices for children aged less than five years who had diarrhea was 15.4% (95% CI: 13.7%-18.2%). Mothers aged 25–34 years (AOR: 0.6, 95% CI: 0.4–0.9), agricultural occupation of mothers (AOR: 2.2, 95% CI: 1.3–3.6), mothers attended four and more antenatal visit (AOR: 2.3, 95% CI: 1.3–4.32) and mothers who had a postnatal checkup within two months of birth (AOR: 1.9, 95% CI: 1.1–3.2) were factors statistically associated with child feeding practices during diarrhea.

Conclusion

Less than one-fifth of under-five children practiced appropriate feeding during diarrheal disease. Working in agriculture and attending antenatal care and postnatal checkup within two months were positively influencing feeding practice. Therefore, the government of Ethiopia needs to strengthen the existing maternal and child health services.

Anaemia and its determinants among young children aged 6-23 months in Ethiopia (2005-2016)

Anaemia in children remains a significant public health threat. Recent numbers from Ethiopia showed that more than two‐thirds of children under the age of 2 years were anaemic. This study aimed to investigate the determinants of anaemia throughout Ethiopia over 11 years, making use of the Ethiopian Demographic and Health Survey (EDHS) rounds 2005, 2011 and 2016. The EDHS made it possible to use data on blood tests and detailed questionnaires among infants and young children. Multivariable logistic regression was applied to assess the association of anaemia and different immediate and underlying determinants. A total of 7,324 children aged 6–23 months were included in the analysis, with prevalences of anaemia being 71% in 2005, 61% in 2011 and 72% in 2016. The following determinants were significantly associated with childhood anaemia throughout the entire period: children younger than 1 year, anaemic mothers and those growing up in pastoralist regions. Risk factors such as diet and infections were consistently not significantly associated with anaemia. Given the tremendous adverse health effects of anaemia in young children, urgent action is needed. Hence, this study recommends nationwide multisectoral interventions targeting pastoralist regions, maternal and child health, screening and treatment of risk groups that could reduce the prevalence of anaemia.

Current Status of Malnutrition and Stunting in Pakistani Children: What Needs to Be Done?

Malnutrition is one of the greatest health challenges that affects about 2 billion people globally. Multiple factors including poverty, food insecurity, maternal health and nutritional status, mother's age at marriage and educational status, low birthweight or small for gestational age (SGA), premature births, suboptimal breastfeeding practices, unhealthy dietary and lifestyle patterns, health and immunization status of children, socioeconomic status of family, environmental and household conditions, together with cultural practices and myths, play vital role in affecting the growth of children at early age. Although child stunting has declined in Pakistan, the reduction rate is only 0.5%, which is very low. This may be due to ineffective or inappropriate intervention programs as they are mostly addressing only one issue at a time and don't use the multi-sector approach to address numerous determinants of stunting. It is therefore important to initiate cost-effective multi-tiered intervention approaches to be implemented at pre-conception, pregnancy and early postpartum stages to prevent the problems of malnutrition and stunting in Pakistani children. This review discusses the etiology of child malnutrition and stunting in Pakistan, role of various determinants of stunting and what type of intervention strategies and approaches should be developed and implemented to deal with these problems. Key teaching pointsMalnutrition is one of the greatest global health challenges.Poverty, food insecurity, socioeconomic status, unhealthy dietary patterns, maternal health and nutritional status, low birthweight, suboptimal breast feeding, environmental conditions, cultural practices and myths, are the main factors for child malnutrition and stunting in Pakistan.The slow reduction rate in child stunting may be due to inappropriate intervention programs.Cost-effective multi-tiered intervention approaches must be implemented at pre-conception, pregnancy and early postpartum stages to prevent child malnutrition and stunting in Pakistan.A holistic approach comprising nutrition and WASH interventions, together with strategies to improve the socioeconomic status be developed and implemented to resolve this dilemma.

Role of Maternal Education and Vaccination Coverage: Evidence From Pakistan Demographic and Health Survey

The aim of this study was to examine the impact of maternal education on child immunization uptake in Pakistan, both at individual and community levels. Pakistan Demographic and Health Survey data were used for analysis. Multilevel logistic regression was used to access the individual- and community-level factors associated with childhood immunization coverage. Out of 6765 children 2659 (39.3%) were fully immunized. Parents education, access to media, and wealth status have positive while ethnicity and working status of mother have a negative impact on the immunization uptake. In the community with a high percentage of educated mothers, the odds of immunized children were high (odds ratio = 1.43, 95% confidence interval = 1.14-1.80) as compared with communities with lower percentage of educated mothers. Moreover, significant variation was found in the likelihood of full immunization across communities. Both community- and individual-level factors have substantial impact on children immunization status. There is a need of improvement in maternal education, poverty alleviation, and removal of rural-urban disparities.