Complementary feeding practices and nutritional status of children 6-23 months old: formative study in Aceh, Indonesia

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.

Assessing the relationship of maternal short stature with coexisting forms of malnutrition among neonates, infants, and young children of Pakistan

Evidence from previous studies suggests a strong association between pediatric undernutrition and maternal stature. However, there's a scarcity of evidence regarding the relationship between maternal stature and pediatric coexisting forms of malnutrition (CFM). This study examined the prevalence and trends of CFM at the individual, household, and community levels, using data from the Demographic & Health Surveys (DHS) of Pakistan. Furthermore, this study assessed the association between pediatric CFM and short maternal stature while adjusting for multiple covariates. A panel cross-sectional analysis was conducted using data from the 2012-2013 and 2017-2018 Pakistan Demographic & Health Survey (PDHS). We included data from 6194 mother-child dyads aged 15-49 years and 0-59 months, respectively, while excluding data from pregnant mothers and dyads with incomplete anthropometric variables and anthropometric outliers. Across the two survey periods, our findings reveal a significant decline in pediatric malnutrition, including CFM, alongside a concurrent increase in maternal overweight/obesity. Three out of four households had either a malnourished mother, and/or a malnourished child, and/or both. Our study demonstrates that short maternal stature increased the odds of various forms of pediatric undernutrition by two-to-threefolds (p < .041), but we did not find an association with wasting, overweight/obesity, and nutritional paradox. This underscores the heightened vulnerability of children born to short-stature mothers to various forms of pediatric undernutrition. Addressing the high prevalence of pediatric undernutrition among children of short-stature mothers necessitates a comprehensive approach that considers an individual's nutritional status throughout their entire life cycle.

Association of food consumption patterns and nutritional status of children under 5 years from rural households in Northern regions, Namibia

BACKGROUND

Many developing countries, Namibia included, have a high prevalence of malnutrition among children, especially in rural subsistence farming areas where inadequate food supply is common. Poor diets in children under 5 years may result in negative health impacts. This study determined the association of food consumption patterns and nutritional status of children under 5 years from rural households in Oshana and Oshikoto regions in Namibia.

METHOD

Employing a cross-sectional descriptive design, 377 children under 5 years participated in this study using purposive sampling. Validated dietary diversity and food frequency questionnaires were used to obtain information on demographic characteristics, commonly consumed food per week, and meal frequencies for the recruited children. Anthropometric measurements were obtained to assess nutritional status of children using Emergency Nutrition Assessment (ENA) software. Descriptive and inferential statistics were computed using the IBM® SPSS® Statistics (Statistical Package for Social Sciences) version 27.

RESULTS

Staple foods, mostly grains, roots and tubers, along with flesh foods, legumes and nuts were commonly consumed. Vitamin A-rich fruits and vegetables were solely consumed in Oshana region (10.7%) and not in Oshikoto. Oshana exhibited a lower dietary diversity score (4±1 SD) compared to Oshikoto (5±1 SD). The prevalence of adequate feeding practices varied, with Oshana having 38.8% meeting minimum milk feeding frequency (MMFF), 55.6% minimum dietary diversity (MDD), 69.8% minimum meal frequency (MMF), and 27% minimum acceptable diet (MAD). In Oshikoto, these figures were lower at 2%, 7%, 32%, and 0.5%, respectively. Stunting, underweight, wasting, and overweight were also documented, with slight differences between the two regions. The study did not find association between nutritional status and MMFF, MDD and MAD. However, significant associations were found between specific food types, amount of food, breastfeeding length, MMF and malnutrition indicators in both regions (p<0.05).

CONCLUSION

Most study participants consumed locally available staple foods. Stunting, underweight, and wasting were prevalent among children in the two regions which were significantly associated to the amount of food consumed, MMF and/ some food types. Improving food environments and eliminating access barriers to diversified diets can mitigate high prevalence of malnutrition among rural children.

Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon

OBJECTIVE

The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator.

METHODS

This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet.

RESULTS

The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet.

CONCLUSIONS

Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.

Optimal timing of introduction of complementary feeding: a systematic review and meta-analysis

CONTEXT

The timing of introducing complementary feeding (CF) is crucial because premature or delayed CF can be associated with adverse health outcomes in childhood and adulthood.

OBJECTIVE

This systematic review aims to evaluate the impact of the timing of CF introduction on health, nutrition, and developmental outcomes among normal-term infants.

DATA SOURCES

Electronic databases and trial registries were searched, along with the reference lists of the included studies and relevant systematic reviews.

DATA EXTRACTION

Two investigators independently extracted data from the included studies on a standardized data-extraction form.

DATA ANALYSIS

Data were meta-analyzed separately for randomized controlled trials (RCTs) and observational studies on the basis of early introduction of CF (< 3 months, < 4 months, < 6 months of age) or late introduction of CF (> 6 months, > 8 months of age). Evidence was summarized according to GRADE criteria. In total, 268 documents were included in the review, of which 7 were RCTs (from 24 articles) and 217 were observational studies (from 244 articles). Evidence from RCTs did not suggest an impact of early introduction, while low-certainty evidence from observational studies suggested that early introduction of CF (< 6 months) might increase body mass index (BMI) z score and overweight/obesity. Early introduction at < 3 months might increase BMI and odds of lower respiratory tract infection (LRTI), and early introduction at < 4 months might increase height, LRTI, and systolic and diastolic blood pressure (BP). For late introduction of CF, there was a lack of evidence from RCTs, but low-certainty evidence from observational studies suggests that late introduction of CF (> 6 months) might decrease height, BMI, and systolic and diastolic BP and might increase odds of intestinal helminth infection, while late introduction of CF (> 8 months) might increase height-for-age z score.

CONCLUSION

Insufficient evidence does suggest increased adiposity with early introduction of CF. Hence, the current recommendation of introduction of CF should stand, though more robust studies, especially from low- and middle-income settings, are needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020218517.

Spatial variation and determinants of inappropriate complementary feeding practice and its effect on the undernutrition of infants and young children aged 6 to 23 months in Ethiopia by using the Ethiopian Mini-demographic and health survey, 2019: spatial and multilevel analysis

Background

Inappropriate complementary feeding practices (IACFPs) are major public health issues in Ethiopia, which usually result in stunting and becoming an intergenerational cycle. However, the spatial patterns and determinants of IACFP and its effect on undernutrition are not well understood in Ethiopia. Therefore, the aim of this study was to explore the spatial patterns and determinants of IACFPs and their effects on the undernutrition of infants and young children (IYC) in Ethiopia.

Methods

This was a nationwide community-based survey study among 1,463 mothers of IYC aged 6-23 months in Ethiopia. The global spatial autocorrelation was assessed using the global Moran's-I to evaluate the spatial clustering of IACFPs. Significant clusters with high and low rates of IACFPs were explored. A multilevel mixed-effect logistic regression with cluster-level random effects was fitted to identify determinants of IACFPs with an AOR and 95% CI.

Results

The prevalence of IACFPs was 90.22%. The spatial pattern of IACFP in Ethiopia was clustered across regions (Global Moran's I = 0.63, Z-score = 12.77, value of p ≤0.001). Clusters with a high rate of IACFP were detected in southern, northwest, and eastern Ethiopia. Individual and community-level variables accounted for 63% of IACFP variation. Mothers with no education were 3.97 times (AOR = 3.97; 95% CI: 1.64-9.60) more likely to have IACFPs than those with higher education. The poorest HHs had 4.80 times the odds of having IACFPs as the richest HHs (AOR = 4.80, 95% CI: 1.23-18.71). The odds of having IACFPs were 2.18 times (AOR = 2.18; 95% CI: 1.28-3.72) higher among babies with no postnatal checkup. Non-breastfed IYC were 2.8 times (AOR = 2.80; 95% CI: 1.29-6.10) more likely to have IACFP when compared with breastfed ones. IYC with the inadequate introduction of solid, semi-solid, and soft foods, inadequate minimum dietary diversity, and inadequate minimum acceptable diet were more likely to have wasting, underweight, and stunting.

Conclusion

This study showed the prevalence of IACFPs was very high, which had an effect on undernutrition and showed spatial variation in Ethiopia. Therefore, the government of Ethiopia and stakeholders should focus on women with no education and the poorest HHs, encourage PNC checkups, and encourage breastfeeding in the hotspot areas to minimize IACFPs in Ethiopia.

Factors associated with fathers' involvement in infant and young child feeding and nurturing care in the urban slums of Bangladesh: A cross-sectional study

Optimal infant and young child feeding (IYCF) and nurturing care during the first years of children's lives are crucial for ensuring their growth and development. The IYCF and nurturing practices are associated with a multifaceted interplay of context-specific factors where fathers' involvement is necessary. The aim of this study is to explore the current scenario of fathers' involvement in IYCF practices in the urban slums of Bangladesh. A cross-sectional survey among the residents of the Sat Tola slum in Dhaka, the capital of Bangladesh was conducted. To avoid social desirability bias, 361 mothers of children aged <24 months were interviewed regarding fathers' involvement. An operational definition of father's involvement was developed based on 11 criteria and then scoring was applied to classify 'Good Involvement' and associated factors were identified using multivariable logistic regression. Fathers' mean age was around 31 (SD ± 6.09) years and the majority of them (44.32%) completed primary education. Fathers had diversified occupations such as day laborer (32.41%), garment worker (22.71%), and business (14.96%). Factors that were significantly associated with the father's involvement in IYCF practices include educational status (aOR = 3.98, 95% CI = 1.91, 8.26, p < .00) and theiroccupational status (aOR = 0.34, 95% CI = 0.16, 0.70, p = .00). Fathers were more active for their first child (aOR: 1.99, 95% CI = 1.04, 3.79, p = .03). Having child in the age group of 14-20 months (aOR = 2.73, 95% CI = 1.32, 5.64, p = <.01) and wife in the age group of 21-30 years (aOR = 2.34, 95% CI = 1.20, 4.58, p = .01) were significantly associated. The study finding explored that fathers' education and occupation as well as mothers' age and education were significantly associated factors for fathers' involvement in the IYCF practices. Further longitudinal studies are recommended to establish the causal relationship between fathers' involvement with IYCF and their impact on child growth and development.

The coverage of indicators of sensitive and specific intervention programs and prevalence of stunting under-five children: A cross-sectional study in Aceh Province, Indonesia

Background: The prevalence of stunting children under-five in Aceh Province is still high due to multiple factors, including the sub-optimal coverage of intervention programs. Aim: This study aimed at finding out the correlation between the coverage of indicators of sensitive and specific intervention programs with prevalence of stunting in Aceh. Methods: A cross-sectional design analyzed secondary data from the Indonesia nutritional status survey and program coverage data in 13 regencies/cities in Aceh Province. The dependent variable was the prevalence of stunting. Meanwhile, the independent variable covered 20 sensitive and specific intervention program indicators. We apply STATA 16 to analyze the correlation between sensitive and specific coverage and stunting prevalence. Results: The coverage of indicators of pregnant women with chronic energy deficiency (CED) receiving supplementary feeding, young children with diarrhea receiving zinc supplementation, parents taking parenting classes, and participation in the health insurance program had a significant correlation with prevalence stunting in Aceh (r = -0.57; r = -0.50; r = -0.65; and r = -0.60). Conclusion: Intervention measures to avert childhood stunting in Aceh should include strengthening supplementary feeding programs for mothers and toddlers, supplementation to prevent toddler diarrhea, and counseling parents on parenting and health insurance.

Determinants and Projections of Minimum Acceptable Diet among Children Aged 6-23 Months: A National and Subnational Inequality Assessment in Bangladesh

Subnational evidence on the level of inequality in receiving complementary feeding practice among Bangladeshi children is lacking. This study estimated inequality in the minimum acceptable diet (MAD) among Bangladeshi children aged 6-23 months, and identified risk factors for and developed projections of the MAD up to 2030. Data from the Bangladesh Demographic and Health Survey 2017-2018 were used in this cross-sectional study. Regression-based slope (SII) and relative index of inequality (RII) were used to quantify the level of absolute and relative inequality, respectively. A Bayesian logistic regression model was used to identify the potential determinants of a MAD and project prevalence up to 2030. About 38% of children aged 6-23 months received a MAD. The national prevalence of a MAD was 26.0 percentage points higher among children from the richest compared to the poorest households, and 32.1 percentage points higher among children of higher-educated over illiterate mothers. Socioeconomic inequality was found to be the highest in the Chattogram division (SII: 43.9), while education-based inequality was highest in the Sylhet division (SII: 47.7). Maternal employment and the number of ANC visits were also identified as significant determinants of a MAD, and the prevalence of a MAD was projected to increase from 42.5% in 2020 to 67.9% in 2030. Approximately two out of five children received a MAD in Bangladesh and significant socioeconomic and education-based inequalities in the MAD were observed. Subnational variation in socioeconomic and education-based inequalities in the MAD requires further public health attention, and poverty reduction programs need to be strengthened.

Food consumption diversity and nutritional status among children aged 6-23 months in Indonesia: The analysis of the results of the 2018 Basic Health Research

BACKGROUND

Stunting among children under five years of age is among the highest in Indonesia. The objective of this study was to investigate the association between food consumption diversity and nutritional status among children aged 6-23 months in Indonesia.

METHODS

The data used came from the results of the 2018 Basic Health Research. The main independent variable was the diversity of food consumption. Control variables included breastfeeding practices and demographic and socioeconomic factors. Using ordinal logistic regression, the role of food consumption diversity in influencing nutritional status was examined after controlling for breastfeeding practices and demographic and socioeconomic factors.

RESULTS

The results of the study showed that the diversity of food consumption (AOR = 1.15; 95%CI: 1.07-1.24) significantly and statistically influenced nutritional status of children age 6-23 months in Indonesia even after controlling for the effects of breastfeeding practices and demographic and socioeconomic factors. Higher odds of having normal nutritional status compared to being stunted or severely stunted was associated with consuming food according to the dietary diversity. Higher odds of having normal nutritional status compared to being stunted or severely stunted was also significantly and statistically associated with being ever breastfed (AOR = 1.33; 95%CI: 1.22-1.46), aged 6-11 months (AOR = 3.07; 95%CI: 2.79-3.38), female (AOR = 1.35; 95%CI: 1.25-1.46), children of non-working mothers (AOR = 1.12; 95%CI: 1.04-1.21), children of higher educated mothers (AOR = 1.50; 95%CI: 1.30-1.72), children from higher wealth quintile households (AOR = 1.65; 95%CI: 1.44-1.85), children from smaller size family (AOR = 1.07; 95%CI: 1.05-1.10), and urban children (AOR = 1.16; 95%CI:1.08-1.25).

CONCLUSION

A profound percentage of children aged 6-23 months in Indonesia experienced stunting and severely stunting. Children who did not receive minimum dietary diversity were more likely to suffer from stunting. The findings from this study suggest that to ensure the achievement of national goal of preventing stunting and sustainable development goal of ending all forms of malnutrition in Indonesia, the strategy should promote the fulfillment of minimum food consumption diversity.

Optimal complementary feeding practices of children aged 6–23 months in three agro-ecological rural districts of Jimma zones of southwest Ethiopia

Despite the critical importance of complementary feeding, large proportions of children in developing countries are sub-optimally fed during 6–23 months of age. In Ethiopia, even though the government has been rolling out infant and young child feeding (IYCF) guidelines, the proportion of mothers adhering to the recommended optimal practices and its associated factors have not been assessed in different agro-ecological areas. Hence, the present study aimed to determine optimal complementary feeding practices and associated factors in three agro-ecological rural districts (high, mid and lowland) of southwest Ethiopia. A community-based cross-sectional study was carried out among 845 mothers-index young children 6–23 months Jimma zone. Multistage sampling was employed to select the study participants. Structured and pretested questionnaires were used to collect data and entered into Epi Data V.1.4.4.0. The data were analysed using SPSS version 20. Binary and multivariable logistic regressions were used to identify factors associated with optimal child-feeding practices. The significance of the association was determined at P < 0⋅05. The overall proportion of optimal complementary feeding practice (OCFP) was 9⋅4 % at 95 % CI (7⋅19, 11⋅08). The timely initiation of complementary feeding, minimum meal frequency, minimum dietary diversity and minimum acceptable diet was 52⋅2, 64⋅1, 17⋅2 and 12⋅2 %. Multivariable logistic regression showed that being in the highland districts, having good maternal knowledge, and mothers having primary school education, having a family size of less than six were positively associated with optimal complementary feeding practices. The findings showed that OCFP was low, especially in the midland agro-ecological districts.

Factors associated with complementary feeding practices among children aged 6-23 months in Indonesia

BACKGROUND

Complementary foods with breastfeeding are foods or drinks given to children aged 6-23 months to meet their nutritional needs. The non-optimal provision of complementary feeding influences malnutrition in children of this age.

AIMS

To analyze the factors associated with complementary feeding practices among children aged 6-23 months in Indonesia.

METHODS

A cross-sectional design was employed using data from the 2017 Indonesia Demographic and Health Survey. A total of 502,800 mothers with children aged 6-23 months were recruited through multistage cluster sampling. Data were analyzed using a logistic regression test to determine the correlation between predisposing, enabling, and reinforcing factors and complementary feeding practices.

RESULTS

A prevalence values of analysis showed that approximately 71.14%, 53.95%, and 28.13% of the children met MMF, MMD, and MAD, respectively. The probability of achieving minimum dietary diversity (MDD) was high in the following: children aged 18-23 months (odds ratio [OR] = 9.58; 95% confidence interval [CI] = 7.29-12.58), children of mothers with higher education (OR = 5.95; 95% CI = 2.17-16.34), children from households with upper wealth index (OR = 2.53; 95% CI = 1.85-3.48), children of mothers who received childbirth assistance by professionals (OR = 1.63; 95% CI = 1.20-2.20), and children of mothers who had access to the Internet (OR = 1.26; 95% CI = 1.06-1.50). Moreover, children from households with the upper wealth index (OR = 1.40; 95% CI = 1.03-1.91), children whose mothers were employed (OR = 1.19; 95% CI = 1.02-1.39) living in urban areas (OR = 1.28; 95% CI = 1.06-1.54) and children of mothers who received childbirth assistance by professionals (OR = 1.33; 95% CI = 0.98-1.82) were more likely to meet Minimum Meal Frequency (MMF). Finally, children aged 18-23 months (OR = 2.40; 95% CI = 1.81-3.17), of mothers with higher education (OR = 3.15; 95% CI = 0.94-10.60), from households with upper wealth index (OR = 1.41; 95% CI = 1.05-2.90) and born with professional childbirth assistance (OR = 1.82; 95% CI = 1.21-2.75) were significantly associated with minimum acceptable diet (MAD).

CONCLUSIONS

The findings revealed that the prevalence of MDD and MAD in Indonesia was low. Strategies such as improving health services, economic conditions, and education level of mothers are needed to improve infant and young child feeding in Indonesia.

Dietary intake and stunting in children aged 6-23 months in rural Sumba, Indonesia

Background Linear growth retardation in the first two years of life leads to numerous harmful consequences. Lack of diversity in the diet and inadequate amounts of complementary food have been associated with stunted growth in children. Objective To assess the dietary intake and investigate for associations with stunting among children aged 6-23 months. Methods This case-control study compared the dietary intake of children aged 6-23 months with and without stunting in the South and West Wewewa subdistricts of Southwest Sumba, East Nusa Tenggara, Indonesia. Complementary food types, dietary diversity, and nutritional intake were assessed and compared between groups. Nutrient intake sufficiency and stunting were analyzed by logistic regression. Results A total of 200 participants were equally allocated into groups with and without stunting. Only 6% of stunted children received adequate complementary food diversity compared to 14% of non-stunted children (P=0.05). The stunted group had significantly lower consumption of flesh foods (beef, fish, poultry, organ meat, and other kinds of meat) compared to the non-stunted group (7% vs. 16% of subjects, respectively; P<0.05). The median total protein intake was also significantly lower in stunted children compared to non-stunted children [7.72 (IQR 6.46, 11.31) g vs. 10.02 (IQR 6.53, 13.95) g, respectively; P<0.05] although no association was found between protein intake sufficiency and stunting in the multivariate analysis. Only maternal unemployment was positively associated with stunting (OR 2.32; 95%CI 1.26 to 4.26). Conclusion Overall, most subjects did not receive sufficient amounts of nutrients. Although dietary diversity was not found to be significantly different between those with and without stunting, a significantly lower proportion of stunted children consumed flesh food. The stunted group also received significantly lower protein from their diet although no association was found between nutrient intake sufficiency and stunting. Further studies are needed to longitudinally assess the effects of macronutrient and micronutrient intake sufficiency on linear growth in children.

Complementary Feeding Practices among Young Children in China, India, and Indonesia: A Narrative Review

Under- and overnutrition are co-existing health issues in several countries across Asia. Poor complementary feeding (CF) is a significant determinant of malnutrition in children and a major cause of morbidity and mortality. The purpose of this narrative review is to summarize the most recent evidence regarding the CF practices in 3 countries with a high prevalence of stunting and overweight, and currently undergoing rapid economic and nutritional transition: China, India, and Indonesia. We focused particularly on the adequacy of CF, based on the WHO feeding indicators (2021) regarding timing, frequency, diversity, as well as the consumption of specific food groups. According to the findings, the majority of infants in the 3 countries are introduced to CF at an inappropriate time: either too early (particularly in urban/rural areas of China and Indonesia) or too late (India) compared with the WHO recommendation. Furthermore, in all countries, diets are characterized by a low variety and frequency of CF and consist mainly of staple foods with poor nutritional quality, such as rice, cereals, or noodles. Nutrient-dense and protein-rich foods, such as foods of animal origin, are either inadequately consumed (rural areas of China and India) or introduced too late (urban areas of China and Indonesia) in the diets of children. In all countries, the consumption of fruit and vegetables, especially during the early CF period, is poor. In contrast, a significant proportion of both urban and rural children, particularly in Indonesia and India, are consuming energy-dense/nutrient-poor snacks and sugary drinks during the CF period. The described practices may pose a significant risk for the development of energy and/or nutrient gaps, magnifying the double and triple burden of malnutrition present in these countries. Further research is warranted to understand the significance of the observed practices for stunting and/or overweight/obesity risk.

Impact of Fortified Infant Cereals on the Burden of Iron Deficiency Anemia in 6- to 23-Month-Old Indonesian Infants and Young Children: A Health Economic Simulation Model

Iron deficiency and iron deficiency anemia (IDA) are highly prevalent among Indonesian infants and young children (IYC). Severe IDA hampers mental development in young children and is linked to lower quality of life and lower productivity as adults. The consumption of fortified infant cereals (FIC) increases iron intake during the weaning period, thus reducing the social burden of IDA. In this manuscript, we aimed to assess the impact of FIC on the burden of IDA on IYC in Indonesia. We analyzed data for IYC aged 6–23 months from the fifth wave (2014–2015) of the Indonesia Family Life Survey (IFLS) and the Indonesia Demographic and Health Survey 2017 (IDHS-17). We adapted a health economic simulation model to estimate the impact of FIC that accounted for lifetime health and cost consequences in terms of reduced future income and DALYs. The mean Hb level was 10.5 ± 1.4 g/dL. Consumers of FIC had a reduced burden of disease (43,000 DALYs; USD 171 million) compared with non-consumers. The consumption of fortified infant cereals plays an important role in reducing the burden of IDA, and it might complement the available strategy of nutritional interventions to address this problem in Indonesian IYC.

Dietary behaviour and anthropometric parameters across the spectrum of pregnant and lactating mother, infant, young children, adolescent girls and reproductive age group females: An assessment of undernutrition among KOL tribe

Introduction

The Kol is an ancient tribal community, who resides in the backward Bundelkhand and Baghelkhand regions bordering UP and MP. Reports claim the high level of exploitation and marginalisation of them by feudal landed landlords. Due to the dearth of studies on Kol community their plight hasn't been addressed effectively so far. Thus, this study was undertaken to assess the dietary behaviour and anthropometric parameters across the spectrum of Maternal, Lactating, Infant, Young Children, Adolescent girls, and reproductive-age women (MIYC-AR) of Kol Community.

Methodology

It was a descriptive observational cross-sectional study, conducted over a period of 6 months; in hard to reach area of Manikpur block, Mangawa, in Chitrakoot district. Pregnant, lactating mothers, infant, young children, adolescent and reproductive age females who were found eligible, were included in the study. A total of 180 participants (30 from each group) were recruited by non-probability purposive sampling. A structured questionnaire was used to collect information regarding Iron folic acid and calcium intake, frequency of major meals and snacks, feeding history of infant and young child. Weight, height, head circumference and mid upper arm circumference were noted and the participants were classified accordingly. Statistical analysis was done using STATA version 13 software.

Results

Only 36% and 30% of the pregnant and lactating mother, respectively, consumed IFA and calcium. The mean diet diversity score was inadequate for all the groups. Maximum among adolescents (70%) and half of the reproductive age group female (50%) were underweight. More than half of the infants (57%) were found to be malnourished on MUAC measurement, while the similar proportion among young children were found to be normal (p < 0.001). Half of the young children had timely initiation of complimentary feeding. But, none among young children received Vitamin A syrup.

Conclusion

Significant higher prevalence of malnutrition was found among infants, adolescents, and reproductive age group females. Strengthening the public distribution system and rigorous supplementary nutrition services through ICDS are the priority intervention needed to address the poor nutritional status of tribe.

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.

Effect of Nutrition Education and Multi-Nutrient Biscuit Interventions on Nutritional and Iron Status: A Cluster Randomized Control Trial on Undernourished Children Aged 6-23 Months in Aceh, Indonesia

Undernutrition and iron deficiencies on under-five children in Indonesia remain high and very closely related to inadequate complementary feeding. This study investigated the effect of weekly nutrition education by home visite using the food monitoring card (FMC) models and daily provision multi-nutrient biscuits and combination on growth and reduction of iron deficiency and anemia among underweight children aged 6-23 mo in Aceh Indonesia. A 6-mo, cluster randomized, control trial was conducted on 121 children received nutrition education (NE), multi-nutrient biscuit (MNB), combination both nutrition education and biscuits (NE+MNB), and control group. The outcome weight gain and prevalence of underweight (weight for age z-score <-2SD) were collected by anthropometric and iron deficiency were serum ferritin measuring with ELISA method. After the 6-mo intervention, the rate of weight gain was higher in combination intervention group 1.51±0.68 kg than multi-biscuit group 1.40±0.72 kg, NE group 1.34±0.66 kg and control group 1.21±0.42 kg, and the rate increase of serum ferritin was higher in combination NE+MNB and biscuit group (2.54 μg/L and 2,17 μg/L). At the end of study there were a significant decrease in prevalence of underweight (p=0.003), the incidence of underweight in NE+MNB (45.2%) lower than NE group (63.3%), MNB group (64.5%) and control group (69,0%) and significant decrease of iron deficiency (p=0.02), the incidence lower in MNB group (6.5%) than NE+MNB (22.6%), NE group (23.3%) and control group (24.1%). The combination of nutritional education and multi-nutrient biscuits intervention improving nutritional and iron deficiency status on undernourished children. These risearch highlight the need integration of nutrition education and food base intervention to prevent underweight and iron deficiency on children 6-23 mo old.

The Association of Feeding Practices and Sociodemographic Factors on Underweight and Wasting in Children in Ethiopia: A Secondary Analysis of Four Health Surveys from 2000 to 2016

BACKGROUND

Feeding practices highly influence the nutritional status of children between 6 and 23 months of age in developing countries, including Ethiopia. Therefore, this study was conducted to investigate the association of feeding practices and sociodemographic factors on underweight and wasting of children aged 6-23 months in Ethiopia.

METHODS

Data on 8003 children 6-23 months of age from four Ethiopia demographic and health surveys (EDHS) from 2000 to 2016 were analyzed using complex sample crosstabs for multivariate analysis. The association of feeding practices and sociodemographic factors on underweight and wasting was assessed via multiple logistic regression analyses adjusting the covariates. The outcomes were reported based on the adjusted odds ratios (ORs) with 95% confidence interval (CI).

RESULTS

Male children, very small at birth size children, diarrhea and fever, and short stature mother were risk factors for underweight and wasting (p < 0.05-0.001). Also, minimum dietary diversity, rich and middle-income families, vitamin A in the previous 6 months and antenatal care visits during pregnancy were protective factors for both underweight and wasting (p < 0.05-0.001). Minimum meal frequency was significantly related to lower odds of wasting (p < 0.001). Higher age of the child was significantly associated with underweight (p < 0.05-0.001); however, it was less likely wasted (p < 0.05-0.01).

CONCLUSION

The present study depicted that among infant young children feeding core indicators except breastfed, all the other indicators did not met the required standard; however, sociodemographic factors on four health surveys from 2000 to 2016 were associated with underweight and wasting in children in Ethiopia.

LAY SUMMARY

• Over the years the prevalence of underweight in children aged 6-23 months in the country has shown a significant improvement from 40.2% in 2000 to 34.7% in 2005, then further reduced to 28.9% and 20.0% in 2011 and 2016 EDHS, respectively.• In the same manner, the prevalence of wasting in children aged 6-23 months in Ethiopia also observed improvement from 18.9% in 2000 to 16.7% in 2005, then further reduced to 15.4% and 13.9% in 2011 and 2016 EDHS, respectively.• Male children, very small at birth size children, diarrhea and fever (for the last 2 weeks), and short stature mother were risk factors for underweight and wasting.• Minimum dietary diversity, rich and middle-income families, vitamin A in the previous 6 months and antenatal care visits during pregnancy were protective factors for both underweight and wasting.• Minimum meal frequency was significantly related to lower odds of wasting.• Higher age of the children was significantly associated with underweight; however, less likely wasted.

Immunization and distance relationship status on the birth events 1000 HPK stunting work in bone health district Barebbo

OBJECTIVE

Stunting is a condition of failure to thrive in children (growth of the body and brain) due to malnutrition.

METHODS

This study aims to determine the risk of immunization status and birth distance of stunting in working area of Barebbo Health Center, Bone. This research was case-control study. The total population in this study were 126 (ratio 1:2) of children aged 0-24 months.

RESULTS

There were 42 respondents and 84 respondents as control. The results of bivariate analysis showed that immunization status was a risk factor for the incidence of stunting (OR=2.328 95% CI: 1.069-5.070) along with birth distance (OR=5.827 95% CI: 1.829-20.223). Meanwhile, maternal education (OR=2.113 95% CI:0.882-5.248) and MP-ASI were not risk factor for stunting (OR=0.352 95% CI: 0.098-1.085).

CONCLUSION

Mothers expected to increase the awareness of nutrition status in the first 1000 days of life.

Dietary Diversity and Associated Factors Among Children Aged 6-23 Months in Indonesia

BACKGROUND

Optimum feeding practice is the key to determine development and growth among infants and young children. Dietary diversity is considered an indicator to assess nutritional adequacy.

OBJECTIVES

This study aimed to determine the factors that associated with minimum dietary diversity types among children aged 6-23 months in Indonesia.

METHODS

Secondary data analysis was carried out for this study using the Indonesian Demographic and Health Survey (IDHS) 2017. The study was conducted with inclusion criteria in women of childbearing age with ages ranging from 15 to 49 years, having children aged 6-23 months, and living with respondents (n = 4861). Data obtained using a questionnaire with cross-sectional design approach. Chi-square test, and logistic regression test were used to measure the determinants of minimum dietary diversity.

RESULTS

The prevalence of children aged 6-23 months who received various foods was 3070 (63.15%) respondents. Age of child of 18-23 months [AOR = 5.88; 95% CI = 4.48-7.14], mother graduated from university level [AOR = 5.16; 95% CI = 2.07-12.89], access to maternal information on mass media (reading newspapers or magazines [AOR = 1.30; 95% CI = 1.10-1.55] and watching television [AOR = 1.56; 95% CI = 1.06-2.30]), and richest wealth quintile [AOR = 1.91; 95% CI = 1.32-2.75] significantly related to minimum dietary diversity in children aged 6-23 months in Indonesia.

CONCLUSIONS

The current study revealed that minimum dietary diversity among Indonesian children remain related to education, mass media and socio-economic level.

PRACTICE IMPLICATIONS

Pediatric nurses can play a critical role here by delivering the messages through educational outreach visits that focus on poor uneducated mother.

Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study

Exclusive breastfeeding has many health benefits for the baby and the mother. This study explored the reasons for the early introduction of supplementary feeding before six months, and the issues faced by parturient women in practicing exclusive breast feeding (EBF) for their HIV-exposed infants in the Eastern Cape, South Africa. Narratives from 319 parturient women with HIV (aged 18 years and above) were collected at three hospitals in the Eastern Cape through semi-structured interviews over a period of five months. Qualitative data were analysed using thematic content analysis. The maternal perception of HIV transmission from breast milk influenced the decision for the immediate introduction of formula feeding. Breast sores, lumps, surgery and perceived insufficiency of milk influenced the decision of mothers to initiate formula feeding within the first two months. However, mothers who initiated complementary feeding after two months were driven by factors common among newborns (refusal of breast milk, baby crying inconsolably and fear of losing weight) and social factors (economic or financial hardships and work-related challenges). Additionally, advice from family members weighed heavily in the decision to switch to complementary feeding, contrary to the healthcare providers' recommendations. Early complementary feeding for HIV-exposed infants is influenced by maternal perceptions of breast milk transmission, breast and infant factors and socio-economic and cultural practices in the region. Thus, behavioural interventions tailored towards promoting exclusive breastfeeding practices in this population, starting from the pre-natal and continuing during the post-partum period, should also target the immediate family members. National policy should focus on creating an EBF-friendly environment at the workplace for women.