Risk factors of poor complementary feeding practices in Pakistani children aged 6-23 months: A multilevel analysis of the Demographic and Health Survey 2012-2013

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.

Functioning of a Nutritional Rehabilitation Center against acceptable levels of care

Background

Establishment of Nutritional Rehabilitation Centers (NRCs) is an initiative under National Rural Health Mission to provide institutional care for children with severe acute malnutrition (SAM). The aim of the study was to assess the effectiveness of nutritional interventional measures in improving the nutritional status of children admitted to an NRC.

Methods

A retrospective health facility-based descriptive study was conducted in the NRC, Rural Health Training Center, All India Institute of Medical Sciences, Raipur.

Results

A total of 765 children were enrolled in the NRC between March 2015 and November 2019, and majority (87.97%) were admitted as per weight for height/length (<-3SD) criteria. The total number of SAM children with complications were 428 (55.94%). Of the 724 total discharges, 498 (68.78%) were cured, 197 (27.2%) were nonresponders and 28 (3.87%) were defaulters.

Conclusion

The findings suggest factors affecting nutritional rehabilitation that are complex and require a more integrated management in the health system and community. Regular review, supportive supervision and identification of nutrient-dense food from locally available low-cost ingredients is the need of the hour.

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.

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.

Infant and young child feeding practices in Lebanon: a cross-sectional national study

OBJECTIVE

To assess infant and young child feeding (IYCF) practices in Lebanon and investigate their associations with socio-demographic and lifestyle factors.

DESIGN

A cross-sectional national survey was conducted in 2012-2013. In addition to a socio-demographic and lifestyle questionnaire, a 24-h dietary recall for the children was collected, with mothers as proxies. IYCF practices were assessed based on the 2021 indicators of the WHO.

SETTING

Lebanon.

PARTICIPANTS

Children aged 0-23 months and their mothers (n 469).

RESULTS

While the majority of infants were ever breastfed (87·6 %), the prevalence of exclusive breast-feeding (BF) in those under 6 months of age was 11·0 %. Early initiation of BF was 28 %. A greater child's birth order, partner's support for BF, higher parental education, maternal BF knowledge and non-smoking were associated with higher odds of meeting BF recommendations. As for complementary feeding, 92·8 % of children (6-23 months) met the minimum meal frequency indicator, 37·5 % met the minimum dietary diversity (MDD) and 34·4 % met the minimum adequate diet (MAD). The consumption of unhealthy food was observed amongst 48·9 % of children, with nearly 37 % consuming sweet beverages. Older maternal age and maternal overweight/obesity were associated with lower odds of meeting MDD and MAD, while child's age and partner's support for BF were associated with higher odds.

CONCLUSIONS

The results documented suboptimal IYCF practices amongst Lebanese children and identified a number of factors associated with these practices. Findings from this study will help guide the development of culture-specific programmes aimed at improving IYCF practices in Lebanon.

Socio-economic inequalities in minimum dietary diversity among Bangladeshi children aged 6-23 months: a decomposition analysis

This study aimed to measure the socio-economic inequalities in having minimum dietary diversity (MDD) among Bangladeshi children aged 6-23 months as well as to determine the factors that potentially contribute to the inequity. The Bangladesh Demographic and Health Survey (BDHS) 2017-2018 data were used in this study. A sample of 2405 (weighted) children aged 6-23 months was included. The overall weighted prevalence of MDD was 37.47%. The concentration index (CIX) value for inequalities in MDD due to wealth status was positive and the concentration curve lay below the line of equality (CIX: 0.1211, p < 0.001), where 49.47% inequality was contributed by wealth status, 25.06% contributed by the education level of mother, and 20.41% contributed by the number of ante-natal care (ANC) visits. Similarly, the CIX value due to the education level of mothers was also positive and the concentration curve lay below the line of equality (CIX: 0.1341, p < 0.001), where 52.68% inequality was contributed by the education level of mother, 18.07% contributed by wealth status, and 14.69% contributed by the number of ANC visits. MDD was higher among higher socioeconomic status (SES) groups. Appropriate intervention design should prioritize minimizing socioeconomic inequities in MDD, especially targeting the contributing factors of these inequities.

Gender-common and gender-specific determinants of child dietary diversity in eight Asia Pacific countries

Background

Optimal child feeding practices contribute to reducing child undernutrition in low- and middle-income countries. Minimum dietary diversity (MDD) is a key indicator of complementary feeding quality for children aged 6-23 months. We aimed to examine the gender-common and gender-specific factors associated with the failure to meet MDD in eight Asia Pacific countries.

Methods

The study used data of children aged 6-23 months from the Demographic and Health Surveys (DHS) conducted in Afghanistan (n = 8410), Bangladesh (n = 2371), Nepal (n = 1478), Pakistan (n = 3490), Cambodia (n = 2182), Indonesia (n = 5133), Myanmar (n = 1379), and Timor-Leste (n = 2115). A total of 41 household, maternal, and child-level variables were examined for association with MDD using univariate and multivariable logistic regressions. All analyses accounted for the survey design and sampling weights.

Results

Being aged 6-11 months, not receiving Vitamin A supplementation, low maternal education, belonging to a low wealth quintile, and having two or more young children in the household were factors related to the failure to meet MDD among both male and female children. Mothers’ not watching TV or not being exposed to media at least once a week, delivery at home, young age, and engagement to non-agricultural work were only significant risk factors among female children. Non-professional delivery assistance, unsafe disposal of children’s stool, tolerant attitudes towards domestic violence, and rural residence were significant factors only among male children.

Conclusions

It is possible that male and female children in the region may consume food in various ways, because the factors for meeting MDD are not the same for different genders of children. It is advised to enhance dietary diversity in child nutrition programmes through gender-specific activities.

Appropriate Complementary Feeding Practice and Its Associated Factors among Mothers Who Have Children Aged between 6 and 24 Months in Ethiopia: Systematic Review and Meta-Analysis

Background

Appropriate complementary feeding practices prevent malnutrition among children. The proportion and determinant factors of appropriate complementary feeding practices identified by different studies were inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis aimed to assess the pooled proportion and determinants of appropriate complementary feeding practices among mothers.

Methods

Databases (PubMed, HINARI, Google Scholar, Cochrane Library, and Web of Science) and university repositories were used to search for important articles. A critical appraisal of the studies was conducted. Data analysis was conducted using STATA version 11. Cochran (Q test) and I² test were used to test the heterogeneity of the studies. Publication bias was checked using the funnel plot for asymmetry and Egger's regression test.

Results

Seventeen primary studies with a total sample size of 9166 mothers were involved in this study. The pooled proportion of appropriate complementary feeding practices among mothers who had infants and young children aged between 6 and 24 months was 21.77 (with a 95% CI: 14.07–29.48). Mothers' educational status of secondary school and above (OR = 3.36 with a 95% CI: 3.03–3.69), having repeated antenatal care visits (OR = 4.77 with a 95% CI: 3.49–6.05), child's age between 12 and 24 months (OR = 3.7 with a 95% CI: 2.75–4.65), having repeated postnatal care visits (OR = 3.17 with a 95% CI: 1.96–4.38), health education (OR = 4.88 with a 95% CI: 3.86–5.9), knowledge of mothers (OR = 4.85 with a 95% CI: 3.77–5.93), maternal age between 18 and 35 years (AOR = 2.67 with a 95% CI: 1.64–3.72), institutional delivery (OR = 2.23 with a 95% CI: 1.79–2.68), and higher household wealth (OR = 2.65 with a 95% CI: 1.46–3.84) were found to be statistically significant associated factors of appropriate complementary feeding practices among mothers.

Conclusions

The pooled proportion of appropriate complementary feeding practices was low in Ethiopia. Knowledge of mothers and maternal health service uptake such as antenatal care, postnatal care, and institutional delivery increase appropriate complementary feeding practices. More focus is required for mothers who have children aged less than 12 months, mothers aged above 35 years and less than 18 years, lower mothers' educational status, and lower household wealth. Therefore, integrated interventions are still required to improve appropriate complementary feeding practices.

Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey

Background

Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices.

Methods

We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators.

Results

The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children’s books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices.

Conclusions

Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13776-8.

Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

Dietary diversity, environment and health-related factors of under-five children: evidence from cassava commercialization households in rural South-West Nigeria

Diverse and quality diets are crucial to sustainable growth and development of under-five children, especially those of rural farming households. This study investigated the dietary diversity, environment, and health-related factors of young children. The study employed the use of cross-sectional survey data from 140 under-five children of cassava farming households in Ogun and Oyo states, South-West Nigeria. The study estimated factors influencing dietary diversity of under-five children and assessed children dietary diversity, and the availability of some environment and health-related factors of the farming households. The findings indicated that 98.7% and 97.5% of children consumed grains, with roots and tubers while 36.7% and 36.3% consumed legumes in Ogun and Oyo states respectively. The results also found that 48.6% of children sampled met the minimum cut-off point of 4 food groups with dietary diversity mean score of 3.28. The logit regression analysis indicated that child's age, mothers' age, distance to farm, and food expenditure were among the significant determinants of children dietary diversity. Therefore, this study seeks the collaborative efforts of stakeholders in providing nutrition-sensitive intervention programs for household members, especially mothers and young children in order to promote consumption of diversified diets and enhance healthy living of rural farming households.

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.

Relationships Among Toilet Sharing, Water Source Locations, and Handwashing Places Without Observed Soap: A Cross-Sectional Study of the Richest Households in Bangladesh

BACKGROUND

A high percentage of the richest households in Bangladesh lack soap at their handwashing places, a problem that is typically considered to be one of the poor.

OBJECTIVE

We investigated toilet sharing practices, locations of water sources, and relevant sociodemographic factors associated with the observed handwashing places that lack soap in the richest (ninth wealth decile) households in Bangladesh.

METHODS

We used data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS). Logistic regression technique was used to investigate how toilet sharing practices, water source locations, and different sociodemographic factors were associated with observed handwashing places without soap.

RESULTS

We found that 25.8% of the richest households were observed to have no soap at their handwashing places. Of these households, those that shared their toilets with another household were 4.6 times (95% CI 3.15-6.60) more likely to observe handwashing places without soap as compared with those that did not share their toilets. Further, the richest households were 4.2 times (95% CI 2.38-7.33) more likely to observe handwashing places without soap if they collected water from their own yard or plot, and 7.1 times (95% CI 3.61-13.97) more likely to observe handwashing places without soap if they collected water from elsewhere in comparison to the reference group that collected water from their own dwelling.

CONCLUSION

Sharing toilet with other households and location of main water source are associated with handwashing places without observed soap in the richest households in Bangladesh. These results can inform discussions of water availability and soap-handwashing-related policy and program development.

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.

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Variation in the Factors Associated With Diet Quality of Children Aged 6 to 23 Months in Low and High Agroecological Zones of Rongai Subcounty, Kenya

BACKGROUND

Adequate quality complementary diets and appropriate feeding practices are important for proper growth and development of young children.

OBJECTIVE

To assess factors associated with diet diversity, meal frequency, and acceptable diet of children aged 6 to 23 months in two agroecological zones of Rongai subcounty, Kenya.

METHODS

A cross-sectional study was conducted among 384 mothers/caregivers with children aged 6 to 23 months. A structured questionnaire was used to assess sociodemographic characteristics and child feeding practices. Diet diversity, meal frequency, and acceptable diet were derived from a 24-hour recall of child's food intake. Factors associated with diet quality were determined using binary logistic regression.

RESULTS

Mean child diet diversity score was 3.54 ± 1.0 of 7 food groups, with 56.8% of the children achieving minimum dietary diversity. A majority of the children (81.8%) received minimum meal frequency (MMF), with significant (P < .05) difference between low (91.1%) and high (75.2%) agricultural potential areas. Children who received minimum acceptable diet (MAD) were only 34.1%. Mother/caregiver education level positively (P < .05) associated with minimum diet diversity in low potential area (adjusted odds ratio [AOR] = 3.79, 95% CI: 1.47-9.75) and with MAD in high potential area (AOR = 1.87, 95% CI: 1.01-3.46). Other factors associated with MDD, MMF, and MAD included household income and slow feeding in low potential area, and child gender and active feeding in high potential area.

CONCLUSION

There is a variation in factors associated with diet quality and child feeding practices in different agroecological zones. Therefore, nutrition education and behavior change communication interventions aimed at improving child nutrition should be context-specific.

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.

Complementary feeding practices and associated factors among children aged 6-23 months in Pakistan

Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey (2017–18). The results show that only 12% of children consume a minimum acceptable diet, 21% achieve minimum dietary diversity, and 38% reach minimum meal frequency. Multivariate regression analysis shows that child age, child weight at birth, mother’s access to newspapers/magazines at the individual level, wealth at the household level, and prenatal visits at the community level are significant predictors of complementary feeding practices among children aged 6–23 months in Pakistan. These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan. This consequently reduces premature mortality and undernutrition.

Are the recommendations of paediatricians about complementary feeding aligned with current guidelines in Uruguay?

OBJECTIVE

To explore Uruguayan paediatricians' personal recommendations about complementary feeding and to assess if they are aligned with current guidelines and scientific evidence.

DESIGN

A questionnaire composed of open-ended questions was used to explore foods recommended to start complementary feeding, foods regarded as the most important during the first meals, recommendations for delayed introduction of foods and foods that should be avoided. Reasons underlying the recommendations were also explored.

SETTING

Montevideo, the capital city of Uruguay (Latin America).

PARTICIPANTS

A total of 212 paediatricians were recruited during a National Pediatrics Conference, organised by the Uruguayan Society of Pediatrics.

RESULTS

The recommendations about complementary feeding provided by paediatricians to parents and caregivers in Uruguay seemed not to be fully aligned with the guidelines provided by the Ministry of Health. Paediatricians recommend a rigid food introduction sequence, characterised by the early introduction of soft pureed vegetables and fruits, followed by meat and the delayed introduction of allergenic foods. Food diversity and the concept of ultra-processed were not frequently identified in the responses.

CONCLUSIONS

Results stress the importance of developing educational and communication approaches targeted at paediatricians to contribute to the uptake of updated recommendations regarding complementary feeding.

Determinants of infant and young complementary feeding practices among children 6-23 months of age in urban Pakistan: a multicenter longitudinal study

Background

Suboptimal feeding practices have a negative impact on children’s health and growth in the first 2 years of life and increase their risk of undernutrition, morbidity, and mortality. The aim of the study was to assess the factors that influence infant and young child feeding practices among urban mothers in a hospital setting at Karachi, Pakistan.

Methods

A longitudinal multi-center cohort study was conducted in four countries, MULTICENTER BODY COMPOSITION REFERENCE STUDY (MBCRS) to produce normal body composition reference data in healthy infants from 3 months to 24 months of age. Repeated anthropometric (weight, length and head circumference) and body composition measurements using “deuterium dilution method” along with 24-h dietary recall questionnaires were performed on 250 healthy term infants at 3, 6, 9, 12, 18, and 24 months of age. The 24-h dietary recall data from this study was used to assess the breastfeeding and complementary feeding practices in children aged 6–24 months.

Results

A total of 250 healthy infants were enrolled in the study. A majority of newborns (75.4%) were exclusively breastfed till 3 months of age; however, by 6 months of age, only 30.2% of infants were exclusively breastfed. Only 44.1% of children aged 6–24 months achieved minimum dietary diversity (MDD), 84.7% achieved minimum meal frequency (MMF), and 44.1% achieved a minimum acceptable diet (MAD). 71.4% achieved MDD and MAD and 100% achieved MMF at 24 months. The bivariate analysis found that breastfed children (OR 3.93, 95% CI 2.72–5.68), with employed mothers (OR 1.55, 95% CI 1.06–2.27) who had graduated from secondary school (OR 1.45, 95% CI 1.08–1.94) were more likely to meet minimum dietary diversity. The multivariable analysis showed that only the child’s age was significantly associated with MDD (p value< 0.0001), with the likelihood of meeting MDD increasing as the children aged; 9 months (OR 18.96, 95% CI 6.63–54.19), 12 months (OR 40.25, 95% CI 14.14–114.58), 18 months (OR 90.02, 95% CI 30.84–262.77) and 24 months (OR 82.14, 95% CI 27.23–247.83).

Conclusion

Our study revealed that Infant and young child feeding practices are significantly associated with maternal education, employment, and the child’s age. Therefore, it is essential that investments be made towards protective breastfeeding and complementary feeding policies and legislations, emphasis on female education and ensuring the availability of affordable nutritious and diverse foods.

Micronutrient Status and Dietary Diversity of Women of Reproductive Age in Rural Pakistan

Consuming a diverse diet is essential to ensure an adequate intake of micronutrients. The aim of this study was to assess the nutritional status and dietary diversity of women of reproductive age (WRA) living in a marginalized community in rural Pakistan. Forty-seven WRA (35 ± 7 years old) who were not pregnant or lactating at enrollment, were recruited to participate in the study. Twenty-four-hour dietary recall interviews were conducted by the study nutritionist, and the data collected were used to create a minimum dietary diversity for women score (MDD-W) on five occasions during the monsoon and winter seasons (October to February). Nutritional status was assessed using anthropometry and biochemical markers of micronutrient status. Height and weight were used to determine body mass index (BMI), and mid-upper-arm circumference was measured. Plasma zinc, iron, and selenium concentrations were measured using inductively coupled mass spectrometry, and iron status was assessed using serum ferritin and blood hemoglobin concentrations. The mean (±SD) food group diversity score was 4 ± 1 with between 26% and 41% of participants achieving an MDD-W of 5. BMI was 27.2 ± 5.5 kg/m² with 28% obese, 34% overweight, and 6% underweight. The prevalence of zinc deficiency, based on plasma zinc concentration, was 29.8%; 17% of the participants had low plasma selenium levels; 8.5% were iron deficient; and 2% were suffering from iron deficiency anemia. The findings indicate that the women living in this community consume a diet that has a low diversity, consistent with a diet low in micronutrients, and that zinc deficiency is prevalent. Public health interventions aimed at increasing the dietary diversity of WRA are needed to improve the micronutrient intake, particularly of zinc, in this population.

COMPLEMENTARY FEEDING INDICATORS FOR CHILDREN AGED 6 TO 23 MONTHS ACCORDING TO BREASTFEEDING STATUS

Objective:

To verify if there are differences among the complementary feeding indicators of children aged 6-23 months according to the breastfeeding status.

Methods:

A cross-sectional study was carried out with 1,355 children aged 6-23 months in 2012 to evaluate five indicators proposed by the World Health Organization (WHO) and modified in accordance with Brazilian’s recommendations “Ten steps to a healthy feeding: a feeding guide for children under two years old”. The indicators used were: I. Introduction of solid, semi-solid or soft foods; II. Minimum dietary diversity; III. Minimum meal frequency; IV. Minimum acceptable diet, and V. Consumption of iron-rich foods. To verify differences between the complementary feeding indicators according to breastfeeding status, the F-statistic was used, with p≤0.05 meaning significant.

Results:

Indicators I, II, and V were similar among breastfed and non-breastfed children; however, indicators III and IV presented a higher proportion of adequacy for non-breastfed children, with 94.9% (CI95% 93.2-96.2) versus 40.3% (CI95% 33.2-47.9) for indicator III, and 57.3% (CI95% 53.2-61.2) versus 23.1% (CI95% 17.4-30.1) for indicator IV.

Conclusions:

Non-breastfed children have better complementary feeding status, but the indicator III takes into account non-breast milk as a meal for non-breastfed children, which increased the number of dairy meals and influenced indicator IV (calculated from indicators II and III).

Assessing weaning stress - Relations between enamel hypoplasia, δ18O and δ13C values in human teeth obtained from early modern cemeteries in Wroclaw, Poland

OBJECTIVES

The aim of this paper is to assess linear enamel hypoplasia (LEH) on canines of adults from early modern Wroclaw cemeteries to compare δ¹³C and δ¹⁸O values in enamel formed before, during and after LEH formation, and to attempt to find a link between the selected indicators of the weaning process.

MATERIAL AND METHODS

15 permanent canines with visible LEH were selected for analysis. Age at LEH formation was estimated using the Reid and Dean method. The perikymata count was used to estimate the duration of LEH formation. Incremental stable oxygen and carbon isotopes analysis was performed on tooth enamel to infer stress related to weaning and dietary patterns. Kruskal-Wallis ANOVA, Mann-Whitney U test and Spearman correlation were used in statistical inference.

RESULTS

The average age of LEH formation was 3.14 years, with an average duration of 111 days. Stable carbon isotope values consistently increase in 73% of the individuals sampled. The values of δ¹⁸O do not show a dominant pattern. The average value of δ¹³C increases over the time of enamel formation. The δ¹³C values collected below LEH were negatively correlated with δ¹⁸O values and the duration of LEH termination.

CONCLUSIONS

Marking of carbon and oxygen isotopes indicates different stages of weaning. Advancements in diet change (determined by higher δ¹³C) corresponds with faster recovery after physiological stress episode. There is no evidence for different breastfeeding models between distinct parishes in early modern Wroclaw.

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.

Water insecurity potentially undermines dietary diversity of children aged 6-23 months: Evidence from India

Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015-2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6-23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender-related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition-independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water-based strategies can be leveraged in multiple ways.

"If there is no water, we cannot feed our children": The far-reaching consequences of water insecurity on infant feeding practices and infant health across 16 low- and middle-income countries

OBJECTIVES

Infant feeding plays a critical role in child health and development. Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study.

METHODS

We interviewed respondents from 19 sites in 16 low- and middle-income countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively.

RESULTS

Water was perceived to directly affect breastfeeding and non-breastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality.

CONCLUSIONS

These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating biocultural pathways by which water impacts infant and young child feeding, it will be possible to understand if, and how, water security can be leveraged to improve child nutrition and health.

Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016

Introducing appropriate complementary feeding at 6 months of age is crucial for the optimal growth and development of an infant. In Ethiopia, however, no previous national‐level studies have examined the trends and associated factors of complementary feeding practices. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016. The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2,520), 2011 (N = 2,850), and 2016 (N = 2,864). Percentage point changes in complementary feeding indicators were estimated to examine the trends over the EDHS years. Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service, and community‐level factors and (a) the introduction of complementary foods, (b) minimum dietary diversity (MDD), (c) minimum meal frequency (MMF), and (d) minimum acceptable diet (MAD). The proportion of mothers who met MDD increased from 6.3% to 13.5% (p < .001), and MAD increased from 4.1% to 7.1% (p = .003) from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%, p = .051) and MMF (from 41.3% to 43.6%, p = .288) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF, and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD. Our analysis of the EDHS suggests that the proportion of MDD and MAD were unacceptably low. Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage, and media exposure.

Children's dietary diversity and related factors in Rwanda and Burundi: A multilevel analysis using 2010 Demographic and Health Surveys

Background

One of the reported causes of high malnutrition rates in Burundi and Rwanda is children's inadequate dietary habits. The diet of children may be affected by individual characteristics and by the characteristics of the households and the communities in which they live. We used the minimum dietary diversity of children (MDD-C) indicator as a proxy of diet quality aiming at: 1) assess how much of the observed variation in MDD-C was attributed to community clustering, and 2) to identify the MDD-C associated factors.

Methods

Data was obtained from the 2010 Demographic and Health Surveys of Burundi and Rwanda, from which only children 6 to 23 months from rural areas were analysed. The MDD-C was calculated according to the 2007 WHO/UNICEF guidelines. We computed the intra-class coefficient to assess the percentage of variation attributed to the clustering effect of living in the same community. And then we applied two-level logit regressions to investigate the association between MDD-C and potential risk factors following the hierarchical survey structure of DHS.

Results

The MDD-C was 23% in rural Rwanda and 16% in rural Burundi, and a 29% of its variation in Rwanda and 17% in Burundi was attributable to community clustering. Increasing age and living standards were associated with higher MDD-C in both countries, and only in Burundi also increasing level of education of the mother's partner. In Rwanda alone, the increasing ages of the head of the household and of the mother at first birth were also positively associated with it. Despite the identification of an important proportion of the MDD-C variation due to clustering, we couldn't identify any community variable significantly associated with it.

Conclusions

We recommend further research using hierarchical models, and to integrate dietary diversity in holistic interventions which take into account both the household's and the community's characteristics the children live in.

The effect of eggs on early child growth in rural Malawi: the Mazira Project randomized controlled trial

BACKGROUND

Stunted growth is a significant public health problem in many low-income countries.

OBJECTIVE

The aim of this study was to evaluate the impact of 1 egg per day on child growth in rural Malawi.

DESIGN

We conducted an individually randomized controlled trial in which 660 children aged 6-9 mo were equally allocated into an intervention (1 egg/d) or control group. Eggs were provided during twice-weekly home visits for 6 mo. Control households were visited at the same frequency. Assessors blinded to intervention group measured length, weight, head circumference, and midupper arm circumference at baseline and the 6-mo follow-up visit. To assess adherence, multipass 24-h dietary recalls were administered at baseline, 3-mo, and 6-mo visits.

RESULTS

Between February and July 2018, 660 children were randomly assigned into the intervention (n = 331) and control (n = 329) groups. Losses to follow-up totaled 10%. In the intervention group, egg consumption increased from 3.9% at baseline to 84.5% and 70.3% at the 3-mo and 6-mo visits, whereas in the control group, it remained below 8% at all study visits. The baseline prevalence of stunting was 14%, underweight was 8%, and wasting was 1% and did not differ by group. There was no intervention effect on length-for-age, weight-for-age, or weight-for-length z scores. There was a significantly higher head circumference for age z score of 0.18 (95% CI: 0.01, 0.34) in the egg group compared with the control group. There was a significant interaction with maternal education (P = 0.024), with an effect on length-for-age z score only among children whose mothers had higher education.

CONCLUSIONS

The provision of 1 egg per day to children in rural Malawi had no overall effect on linear growth. A background diet rich in animal source foods and low prevalence of stunting at baseline may have limited the potential impact. This trial was registered at clinicaltrials.gov as NCT03385252.

Prevalence and factors associated with complementary feeding practices among children aged 6-23 months in India: a regional analysis

Background

Inappropriate complementary feeding practices significantly contribute to undernutrition among children under 2 years of age in India. However, there is limited up-to-date evidence on the prevalence and factors associated with complementary feeding practices to guide policy actions at the subnational level in India. We investigated the regional prevalence and factors associated with complementary feeding practices in India.

Methods

This study used a sample of 69,464 maternal responses from the 2015–16 National Family Health Survey in India. The prevalence of complementary feeding indicators was estimated using data for each administrative region, namely: North (n = 8469), South (n = 12,828), East (n = 18,141), West (n = 8940), North-East (n = 2422) and Central (n = 18,664). Factors associated with complementary feeding by region in India were investigated using logistic regression Generalized Linear Latent and Mixed Models (GLLAMM) with a logit link and binomial family that adjusted for clustering and sampling weights.

Results

The study showed a wide variation in the prevalence of introduction of solid, semi-solid or soft foods (complementary foods) among infants aged 6–8 months in regional India; highest in the South (61%) and lowest in the Central and Northern regions (38%). Similarly, minimum dietary diversity (MDD) was highest in the South (33%) and lowest in the Central region (12%). Both minimum meal frequency (MMF) and minimum acceptable diet (MAD) varied substantially across the regions. The factors associated with complementary feeding practices also differed across Indian regions. Significant modifiable factors associated with complementary feeding practices included higher household wealth index for the introduction of complementary foods in the North and Eastern India; higher maternal education for MMF and MDD in the North and Central regions; and frequent antenatal care visits (≥4 visits) for all indicators but for different regions.

Conclusion

Our study indicates that there are wide differences in regional prevalence and factors associated with complementary feeding practices in India. The improvement of complementary feeding practices in India would require national and sub-national efforts that target vulnerable mothers, including those with no education and limited health service contacts.

Predictors of complementary feeding practices in Afghanistan: Analysis of the 2015 Demographic and Health Survey

Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi-solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6-8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6-23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community-level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda.

Aiming higher for maternal and child nutrition in South Asia

The sustainable development of nations relies on children developing to their full potential and leading healthy, productive, and prosperous lives. Poor nutrition in early life threatens the growth and development of children, especially so in South Asia, which has the highest burdens of stunting, wasting, and anaemia in the world. Targeted actions to reduce stunting and other forms of child malnutrition in South Asia should be informed by an understanding of what drives poor nutrition in children, who is most affected, and effective programme approaches. To this end, the UNICEF Regional Office for South Asia commissioned a series of papers in 2016–2017 to fill knowledge gaps in the current body of evidence on maternal and child nutrition in South Asia, including analyses of: (a) the links between anthropometric failure in children and child development; (b) the time trends, current distribution, disparities and inequities of child stunting, wasting and anaemia, and their direct and underlying causes, including maternal anaemia, low birth weight, breastfeeding, and complementary feeding; (c) policy and programme actions to increase the coverage of nutrition interventions during pregnancy, improve breastfeeding practices, and care for severely wasted children. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy, and programme actions to improve maternal and child nutrition in South Asia.

Sociodemographic factors associated with inadequate food group consumption and dietary diversity among infants and young children in Nepal

Infants and young children need diversified diets to grow healthy. However, there is limited evidence on factors associated with consumption of various food groups. This study aimed to identify the sociodemographic factors associated with inadequate food group consumption and not meeting the minimum dietary diversity (MDD) among infants and young children aged 6-23 months in Nepal. Using cross-sectional data from the 2016 Nepal Demographic and Health Survey, the factors at the individual-, household-, and community-levels associated with not consuming foods from the seven food groups, which are grains, roots and tubers, legumes and nuts, dairy products, flesh foods, eggs, vitamin-A rich fruits and vegetables, and other fruits and vegetables, and not meeting the MDD were examined. The least consumed food group was eggs, followed by flesh foods and 46.5% of children received the MDD. Children aged 6-11 months had higher odds of not consuming foods from the seven food groups and not meeting the MDD than older children. Children from the poorest quintile had higher odds of not consuming legumes and nuts, dairy products, flesh foods, and other fruits and vegetables, and not meeting the MDD. Children from Terai/Madhesi Other had higher odds of not consuming foods from the seven food groups compared to those from the other groups. Children from Province 2 had higher odds of not consuming eggs, vitamin-A rich fruits and vegetables, and other fruits and vegetables, and not meeting the MDD. Dietary diversity among children in Nepal needs improvement. National policies and programs need to promote the consumption of diverse food groups by considering different sociodemographic characteristics.

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

Background

Though infant and young children should be fed according to a minimum acceptable diet to ensure appropriate growth and development, only 7% of Ethiopian 6–23 months age children meet the minimum acceptable dietary standards, which is lower than the national target of 11% set for 2016. Therefore, this study aims to assess the individual and community level factors affecting feeding according to minimum acceptable diet among 6–23 months age children in Ethiopia.

Methods

This study analyzed retrospectively a cross-sectional data on a weighted sample of 2919 children aged 6–23 months nested within 617 clusters after extracting from Ethiopian Demographic and Health Survey 2016 via the link www.measuredhs.com. By employing bi-variate multilevel logistic regression model, variables which were significant at the p-value < 0.25 were included in multivariable multilevel logistic regression analysis. Finally, variables with a p-value < 0.05 were considered as significant predictors of minimum acceptable diet.

Results

Only 6.1% of 6–23 months age children feed minimum acceptable diet in Ethiopia. Children 18–23 months age (AOR = 3.7, 95%CI 1.9, 7.2), father’s with secondary or higher education (AOR = 2.1, 95%CI 1.2, 3.6), Employed mothers (AOR = 1.7, 95%CI 1.2, 2.5), mothers have access to drinking water (AOR = 1.9, 95%CI 1.2, 2.9), mothers with media exposure (AOR = 2.1 95%CI 1.1, 2.7) were positive individual level predictors. Urban mothers (AOR = 4.8, 95%CI 1.7, 13.2)) and agrarian dominant region (AOR = 5.6, 95%CI 2.2, 14.5) were community level factors that significantly associated with a minimum acceptable diet of 6–23 months age children.

Conclusion

Both individual and community level factors were significantly associated with a minimum acceptable diet of 6–23 months age children in Ethiopia, suggesting that nutritional interventions designed to improve child health should not only be implemented at the individual level but tailored to community context as well.

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

BACKGROUND/OBJECTIVES

The 6-23 months for infants is the longest period in the "first 1,000 days" of life. This period is very important for child development, so complementary feeding (CF) practices should be optimized to maximize children's potential for growth and development. The aim of this study was to analyze the CF practices and nutritional status of children aged 6-23 months.

SUBJECTS/METHODS

For this cross-sectional study, 392 children aged 6-23 months were selected using stratified random sampling. Socio-demographic data were collected through interviews. CF practices, collected by interviews and repeated 24-hour food recall method, were the timely introduction of CF, minimum meal frequency, dietary diversity and minimum acceptable diet, consumption food rich in proteins and vitamin A. Nutritional status was assessed using the indicators of underweight, wasting and stunting. To analyze the association between socio-demographic indicators and CF with nutritional status, the chi-square test with a confidence interval of 95% was used.

RESULTS

Results showed that 39% were exclusively breastfed, only 61% received prolonged breastfeeding and 50% received timely introduction of CF. Minimum meal frequency was met by 74% of subjects, but dietary diversity and minimum acceptable diet were only realized in 50% and 40% of the children, respectively. The prevalence of underweight, wasting, and stunting were 26%, 23%, and 28%, respectively. Age of the child, birth order, birth weight, parents' education level, family size and incidence of fever and diarrhea during the previous two weeks were associated with underweight, while child's birth order, fathers' education level, mother's age, family size, completion of the age-appropriate vaccination and fish consumption frequency were associated with wasting. Age of the child, incidence of fever and acute respiratory infection, and fortified food consumption were associated with stunting.

CONCLUSIONS

Suboptimal CF practices and high prevalence of underweight, wasting and stunting were found among children aged 6-23 months old in Aceh. These results highlight the need to improve CF and nutritional status.

Socio-economic differentials in minimum dietary diversity among young children in South-East Asia: evidence from Demographic and Health Surveys

OBJECTIVE

To investigate the socio-economic differentials underlying minimum dietary diversity (MDD) among children aged 6-23 months in three economically diverse South-East Asian countries.

DESIGN

The outcome variable MDD was defined as the proportion of children aged 6-23 months who received foods from four of the seven recommended food groups within the 24 h prior to interview. The association between socio-economic factors and MDD, adjusting for relevant characteristics, was examined using logistic regression.

SETTING

We used cross-sectional population data from recent Demographic and Health Surveys from Cambodia (2014), Myanmar (2015-16) and Indonesia (2012).

SUBJECTS

Total of 8364 children aged 6-23 months.

RESULTS

Approximately half of all children met the MDD, varying from 47·7 % in Cambodia (n 1023) to 58·2 % in Indonesia (n 2907) and 24·6 % in Myanmar (n 301). The likelihood (adjusted OR; 95 % CI) of meeting MDD increased for children in the richest households (Cambodia: 2·4; 1·7, 3·4; Myanmar: 1·8; 1·1, 3·0; Indonesia: 2·0; 1·6, 2·5) and those residing in urban areas (Cambodia: 1·4; 1·1, 1·9; Myanmar: 1·7; 1·2, 2·4; Indonesia: 1·7; 1·5, 1·9). MDD deprivation was most severe among children from the poorest households in rural areas. The association between mother's labour force participation and MDD was positive in all three countries but reached significance only in Indonesia (1·3; 1·1, 1·5).

CONCLUSIONS

MDD deprivation among young children was significantly high in socio-economically disadvantaged families in all three study settings. MDD requirements are not being met for approximately half of young children in these three South-East Asian countries.

Stagnating trends in complementary feeding practices in Bangladesh: An analysis of national surveys from 2004-2014

Bangladesh has experienced steady socio‐economic development. However, improvements in child growth have not kept pace. It is important to document complementary feeding (CF) practices—a key determinant of children's growth—and their trends over time. The study aims to examine trends in CF practices in children aged 6–23 months using data from Bangladesh Demographic and Health Surveys conducted in 2004, 2007, 2011, and 2014. Multilevel logistic regression models were applied to identify independent predictors of four CF practice indicators among children 6–23 months, namely, timely introduction of complementary foods, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. Introduction of complementary foods was achieved among 64–71% of children between 2004 and 2014. The proportion meeting minimum meal frequency increased from 2004 to 2007 (71–81%) and declined and held steady at 65% from 2011 to 2014. The proportion meeting minimum dietary diversity in 2011 and 2014 was low (25% and 28%), and so was minimum acceptable diet (19% and 20%). From 2007 to 2014, child dietary diversity decreased and the most decline was in the consumption of legumes and nuts (29% to 8%), vitamin A‐rich fruits and vegetables (54% to 41%), and other fruits and vegetables (47% to 20%). Young child age (6–11 months), poor parental education, household poverty, and residence in the Chittagong and Sylhet independently predicted poorer feeding practices. Dietary diversity and overall diet in Bangladeshi children are strikingly poor. Stagnation or worsening of feeding practices in the past decade are concerning and call for decisive policy and programme action to address inappropriate child feeding practices.

Risk factors of poor complementary feeding practices in Pakistani children aged 6-23 months: A multilevel analysis of the Demographic and Health Survey 2012-2013

Appropriate feeding practices are crucial for survival, growth, and development in childhood. This paper analyzes Pakistan's Demographic and Health Survey 2012-2013 to fill the knowledge gap in risk factors of poor complementary feeding practices in Pakistani children. Multilevel models were applied to fit the multistage cluster sample of 2,827 children aged 6-23 months from 489 communities. Introduction of solid, semi-solid, or soft foods (intro) was achieved in 67% infants aged 6-8 months. Among children aged 6-23 months, the proportion of children meeting minimum meal frequency, dietary diversity (MDD), and acceptable diet criteria were 63%, 22% and 15%, respectively. Consumption of legumes and nuts, flesh foods, and vitamin A-rich fruits and vegetables was low in all children (6-19%), even among children who met the MDD criteria (15-55%). Younger child age, especially between 6 and 11 months and delayed maternal postnatal checkup were significant individual-level risk factors that consistently increased the odds of not meeting all four criteria examined. Fewer antenatal care visits predicted the odds of achieving intro and minimum meal frequency while younger maternal age and household poverty predicted the odds of achieving MDD and minimum acceptable diet. Community-level factors included geographic region and general access to maternal and child health care services. The overall poor quality of children's complementary diets in Pakistani calls for stronger policy and program action to promote the consumption of key nutrient-dense foods while prioritizing interventions for the most vulnerable children and populations.

First foods: Why improving young children's diets matter

Globally, only 52% of children aged 6-23 months meet the minimum meal frequency and a mere 29% meet the minimum dietary diversity, with large disparities across and within regions. With most of the stunting occurring during the first thousand days-from conception to age 2 years-improving complementary feeding in children 6-23 months old is an urgent priority. With this evidence in mind, UNICEF collaborated with the governments of India and Maharashtra to convene a global meeting in Mumbai, India, under the theme: First Foods: A Global Meeting to Accelerate Progress on Complementary Feeding in Young Children (November 17-18, 2015). The global meeting provided a platform that aimed to (a) synthesize the biological and implementation science on complementary feeding; (b) review the practice and experience in improving access to nutritious complementary foods and good complementary feeding practices; and (c) consolidate a strong evidence base that can inform the development of strategies and approaches to improve complementary feeding that are fit to context. This overview paper summarizes the rationale on why improving complementary foods and feeding for infants and young children matters and what it takes to improve them. It builds on the papers presented at the First Foods Global Meeting and those commissioned as a follow on to it.

Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014

There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6–23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO‐UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community‐level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children.