Determinants of inadequate complementary feeding practices among children aged 6-23 months in Ghana

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey

Introduction

Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data.

Methods

Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant.

Results

The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use.

Conclusion

Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

Suboptimal micronutrient intake among children aged 6 to 23 months in Ethiopia: Further analysis of the demographic and health survey

BACKGROUND

The recommended essential micronutrient such as food rich in vitamin-A or iron, multiple micronutrient powder or iron supplement, routine daily consumption of iodine, and vitamin-A supplement are deficient among children in Ethiopia. This has been a significant public health problem despite the government efforts. Although few studies have examined the micronutrient intake among children, they are limited in scope and methodological measurements. Analyzing the micronutrient intake among children across all regions and leveraging all essential micronutrient elements are crucial for generating improved evidence to better inform policy. Thus, we examined the micronutrient intake among children aged 6 to 23 months in Ethiopia.

METHODS

We used data from the Ethiopian Demographic and Health Survey. A two-stage stratified sampling technique was employed, and 1392 children aged 6 to 23 months were included in our analysis. We conducted a multilevel mixed-effect binary logistic regression analysis to identify determinants of micronutrient intake. In the final model, we used a p-value of less than 0.05 and Adjusted Odds Ratio (AOR) with their 95% confidence interval (CI).

RESULTS

We found that only 27.6% (95% CI: 26.8-31.6) of children aged 6 to 23 months were received the recommended micronutrients in Ethiopia. We identified that maternal educational status (Educated mothers (AOR = 2.09, 95%CI:1.23-3.58)), health facility delivery (AOR = 2.14, 95%CI:1.42-2.98), household wealth status (middle quantile (AOR = 1.80, 95%CI:1.01-3.21)), children's age (12 to 23 months age (AOR = 2.36, 95% CI: 1.33-4.21)), and mother's exposure to media (AOR = 1.70, 95%CI: 1.42-2.04) were increased micronutrient intake, whereas residing in the rural communities (AOR = 0.27, 95%CI: 0.21-0.34) decreased micronutrient intake.

CONCLUSIONS

Nearly three-fourths of children aged 6 to 23 months did not receive the recommended essential micronutrients in Ethiopia. Therefore, there is a need to broaden strategies aimed at enhancing the intake by improving information and knowledge dissemination among mothers during facility visits and through media channels.

Minimum acceptable diet and associated factors among 6-23 months old children enrolled in outpatient therapeutic program in the Tulla district, Sidama region, Ethiopia: a community-based cross-sectional study

BACKGROUND

Improving the minimum acceptable diet (MAD) is essential for ensuring optimal growth and development of children, as well as preventing malnutrition and its consequences. Previous studies in Ethiopia have focused on the magnitude and determinants of a minimum acceptable diet. However, much emphasis was not given to minimum acceptable diet and its associated factors among 6-23 months old children enrolled in Outpatient therapeutic programs (OTP), particularly, in the study area. This study determines the minimum acceptable diet and associated factors among 6-23-month-old children enrolled in OTP.

METHODS

A community-based cross-sectional study was conducted among 346 randomly selected mothers with children aged 6-23 months who were admitted to the OTP. The data were collected using interviewer-administered structured questionnaires. The data were entered, cleaned, coded into Epidata version 4.6, and exported to SPSS version 26 for further analysis. Multivariate logistic regression was used to assess the determinants of MAD.

RESULTS

The overall prevalence of minimum Acceptable diet among children aged 6-23 months enrolled to OTP was 14.5% (95% CI: 12.02-19%). The odds of MAD were 1.9 times higher among children aged 18-23 months compared to children aged 6-11 months (AOR = 1.9, 95% CI ((1.2 3.9). The odds of MAD were 2.9times higher in children whose mothers had a good knowledge on recommended feeding (AOR = 2.9, 95% CI (1.2, 6.35). Mothers who had no formal education were 81% less likely to provide minimum acceptable diets for their children compared to their counterpart.(AOR = 1.94, 95% CI = 1.24, 4.19).

CONCLUSION

The practice of a minimum acceptable diet is inadequate. Nutrition education should be emphasized to improve the mothers' nutrition knowledge regarding infant and young child feeding recommendations, to support mothers in overcoming barriers to feeding their children with adequate diets, and to foster complementary feeding practices for malnourished children.

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

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

Minimum acceptable diet and associated factors among 6-23 months children in rural households with irrigated users and non-irrigated users in Ethiopia: a comparative cross-sectional study

INTRODUCTION

Poor quality of complementary foods is a key contributor to undernutrition even with optimal breastfeeding. Minimum Acceptable Diet (MAD) has tremendous health and nutrition benefits but only 12% of Ethiopian children's feeding practices meet its standards. The Ethiopian government has recently increased efforts to expand nutrition-sensitive irrigation to improve child nutrition. However, the impact that irrigation has brought on the minimum acceptable diet practice of children below two years has not yet been studied. The aim of this study was to compare the magnitude of MAD practice and associated factors among children aged 6-23 months in households with irrigated users and non-users of North Mecha district, Ethiopia.

METHODS

A community-based comparative cross-sectional study was employed among 824 mother-child pairs. For infant and young child feeding practices, the data collection tools were adapted from the World Health Organization's standardized questionnaire developed in 2010. X2 test was used to compare the MAD practices of irrigated users' and non-irrigated users. Bivariate and multivariable logistic regression analyses were performed to see the predictor variables. p-value < 0.05 was taken to declare statistical significance.

RESULTS

The present study showed that the MAD practice of under two children in irrigated users is significantly higher than non-users (X2 = 13.91, P <.001). Maternal involvement in decision-making [AOR = 4.37, 95% CI: (2.05,9.33)], initiation of breastfeeding [AOR = 5.29, 95% CI: (2.393,11.672)], and history of illness [AOR = 4.10, 95%CI: (1.48,11.38)] were independent predictors for MAD practice among irrigated users. Whereas, maternal involvement in decision making [AOR = 4.71, 95% CI: ( 2.28, 9.75)], place of delivery [AOR = 2.51, 95% CI: ( 1.14, 5.55)], postnatal care (PNC) follow-up [AOR = 3.01, 95%CI: (1.57, 5.77)] and growth monitoring and promotion (GMP) service utilization [AOR = 4.64, 95% CI: (2.40, 8.95)] were the independent predictors among the non-users.

CONCLUSION

MAD practice was much higher in irrigated users than in non-irrigated users. Involvement in a decision, place of delivery, PNC, and GMP are independent predictors of MAD in children from non-irrigated households. The study suggested that expanding access to irrigation to households may be the best approach to improve child nutrition.

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.

Factors associated with food consumption and dietary diversity among infants aged 6-18 months in Ashanti Region, Ghana

BACKGROUND

Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants' diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants.

METHODS

In this cross-sectional study among 1503 mothers-infant (aged 6-18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother's socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity.

RESULTS

About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6-11 months) (74%, p<0.001) compared with older children (12-18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4-4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2-93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2-9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7-3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5-1.6) than those with less knowledge.

CONCLUSIONS

Low DD was common among infants and associated with infants age, caregivers' areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants.

Determinants of inappropriate complementary feeding among children 6-23 months of age in Dessie City Northeast Ethiopia: a case-control study

BACKGROUND

Inappropriate complementary feeding is one of the leading causes of malnutrition among children 6-23 months old and delays children's growth milestone. The determinants of inappropriate complementary feeding practice have diverse natures, so that many of the previous studies fail to generate adequate evidence on it. This study aim to address the determinants of in appropriate complementary feedings at community level.

METHODS

A community-based unmatched case-control study design was carried out among children 6-23 months of age in Dessie City from April 13, 2021 to May 13, 2021. Nine kebeles were selected by simple random sampling method. One month prior to the data collection time survey was conducted and 482 samples were taken from the preliminary survey data; 241 cases and 241 controls by computer generated random numbers. Interviewer administered questionnaire was used to investigate potential determinants of inappropriate complementary feeding practice. Binary logistics regression was used to identify independent determinants.

RESULTS

Part working situation of mother [AOR = 0.21 CI: 0.08, 0.52] was negatively associated with inappropriate complementary feeding. Having no post-natal care visit [AOR = 4.062 CI:2.35,7.02], poor wealth status [AOR = 2.7 CI:1.09,6.68], food in-security [AOR = 4.49 CI:1.94,10.37], home delivery [AOR = 4.33 CI:1.43,13.15], having poor knowledge on infant and young child feeding [AOR = 5.94 CI:2.8,12.6], having no health education on complementary feeding [AOR = 2.54 CI:1.28,5.06] and father's job [AOR = 2.2 CI:1.17,4.1] were found to be positively associated with inappropriate complementary feeding.

CONCLUSION

Mothers' work situation, fathers' job, wealth index, food security, mothers' knowledge on infant feeding, post-natal care, health education on infant feeding and place of delivery were independent determinants for inappropriate complementary feeding. Thus, interventions shall effectively address those factors to alleviate the problem.

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.

Growth Assessment of Under-Five Children of Employed and Unemployed Mothers of Etawah District, Uttar Pradesh: A Cross-Sectional Study

Introduction The under-five age group is crucial because the health profile of this age group will have a huge effect on the future development of the nation. Early infancy is marked by several distinct developmental characteristics. Progress in each domain of childhood development is used to track a child's development. Objectives The objectives of the present study were to assess and compare the growth of under-five children of employed and unemployed mothers in the Etawah District of Uttar Pradesh, India. Material and methods A community-based cross-sectional survey was carried out in Etawah district's urban and rural areas between January 2021 and June 2022. A total of 200 mothers with children under the age of five were recruited using the purposive sampling method. To gather pertinent information, a semi-structured, pre-tested, interviewer-administered questionnaire was used. Results In the present study on the comparison of the growth of children among employed and unemployed mothers, it shows that 48 children (50.5%) with a weight between 10.5 and 15 kg were of employed mothers, while 52 children weighing less than 10.5kg were of unemployed mothers (p<0.001). Forty-four children (57.1%) with a chest circumference of more than 48 cm were of employed mothers, while 26 children (78.8%) with a chest circumference of less than 45 cm were of unemployed mothers (p = 0.001). Conclusion The present study indicates that statistically significant differences were found in age-appropriate gain in weight and chest circumference, which was higher among the children of employed mothers in comparison to children of unemployed mothers. There was no statistically significant difference in age-appropriate gain in height, head circumference, or mid-upper arm circumference among the children of employed mothers and unemployed mothers.

Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda

The safety of homemade weaning foods in low- and middle-income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6-23 months of age in Amuru and Nwoya districts, Northern Uganda, between March 2019 and June 2019. A cross-sectional study was conducted involving 180 caregivers. Data were collected using semi-structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logistic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision-making on household income (p = .006) and households with older children (p = .041). A significant positive correlation was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.

Early initiation of breastfeeding, bottle feeding, and experiencing feeding challenges are associated with malnutrition

Malnutrition remains a public health concern amidst low proportions of the core infant and young child feeding (IYCF) practices, yet, data on specific child feeding practices that are associated with undernutrition are rare. Hence, this study sought to assess child feeding practices and their association with undernutrition among young children. An analytical cross-sectional design was used among mothers/caregivers with children aged 6-23 months, attending child welfare clinics in Techiman municipality, Ghana. Simple random sampling was used to select 8 health facilities, and 403 participants were selected from those facilities using proportional stratification. A 24-h dietary recall based on seven food groups was used to collect data on children's dietary intake and used to derive WHO child feeding indicators. The length, weight, and age of children were taken and used to compute anthropometric z-scores. The proportions of children who met their minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were 44%, 56%, and 36% respectively. Children 6-8 months [AOR=2.24, CI (1.037-4.841); p = .04] and 9-11 months [AOR=2.47, CI (1.096-5.573); p = .029], those who were not breastfed within the first hour of delivery [AOR = 3.56, CI (1.833-6.912), p < .001], and those who were bottle fed [AOR = 2.87, CI (1.374-5.973); p = .005] were more likely to be wasted. Children 6-8 months [AOR = 0.29, CI (0.126-0.672); p = .004] and 9-11 months [AOR = 0.24, CI (0.104-0.544); p = .001] and those who experienced feeding challenges [AOR = 0.52, CI (0.301-0.905); p = 0.021] were protected against stunting. The percentages of children who met their MDD, MMF, and MAD were low and not associated with undernutrition. Early initiation of breastfeeding and bottle feeding were associated with acute malnutrition and experiencing feeding challenges was associated with chronic malnutrition. Promoting appropriate child feeding practices can reduce the risk of undernutrition.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

FINDINGS

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

CONCLUSION

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

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Complementary feeding practices among mothers having children less than two years old attending well-baby clinics in Jazan City, Saudi Arabia

Introduction

infant feeding practices are important determinants of growth and development not only in infancy but also in later life. The main objective of this study is to describe infant feeding practices and the factors affecting complementary feeding (CF) among mothers in Jazan City.

Methods

an observational cross-sectional study was conducted among 400 mothers having children less than 24 months old, attending the well-baby clinics in Primary Health Care Centers (PHCCs) in Jazan City, Saudi Arabia. A structured questionnaire was used to collect data in a face-to-face interview.

Results

on the mother's level of knowledge regarding proper infant feeding, 49% scored high, 41% scored medium, and 9.75% scored low. The mother's educational level, working status, family income, and knowledge source played a significant role in the knowledge scores (p < 0.05 for all). Overall, 15.8% of the mothers never breastfed (BF) their children, 39.8% BF less than six months, 17.5% BF 6-12 months, and 27% BF over 12 months. Breastfeeding feeding (BF) duration is significantly associated with maternal literacy and family income (p = 0.006 for both). Overall, approximately one-third of the women (36.2%) started CF at six months or later, while 63.8% started CF at 4-6 months.

Conclusion

Jazan women use some positive infant feeding practices, including breastfeeding. One-third of the women started CF at six months or later, which is considered the optimal time for the CF introduction. More nutrition education is necessary to raise maternal awareness regarding appropriate infant feeding and weaning practices.

Factors associated with appropriate complementary feeding: A scoping review

PROBLEM

Childhood stunting becomes a vital point of an underlying problem in early life. Appropriate and adequate complementary feeding is necessary for children to prevent malnutrition and introduce healthy eating habits. Knowledge of factors related to complementary feeding practices is needed to design strategies that improve optimal complementary feeding and avoid malnutrition in children. However, factors related to appropriate complementary feeding practices have not been systematically examined; hence, the present study aims to synthesize the available evidence on factors associated with proper complementary feeding practices.

METHODS

A scoping review was conducted. Five databases were searched for relevant studies, including Medline, Embase, Cochrane, CINAHL, and Web of Science. The studies selected for review were those published in English from 2009 to 2022 on complementary feeding practices and related factors, measuring at least three complementary feeding indicators, and available in full text. The criteria resulted in 30 eligible articles that were selected, extracted, and then analyzed using descriptive and content analysis.

FINDING

Factors associated with complementary feeding practice include maternal factors (knowledge, attitude, self-efficacy, parity, antenatal care visit, place of delivery, and postnatal check-up), socio-environmental factors (age, educational level, income, employment status, residence, household size, mother's ethnicity, and support) and informational factors (exposure to media, source of information and intervention).

CONCLUSION AND IMPLICATION

Maternal, socio-environmental, and informational factors are associated with appropriate complementary feeding in infants and young children. Further research is necessary to identify causal relationships between the three groups of factors and complementary feeding practices.

Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs

We estimated how micronutrient needs of young children, aged 6-24 months were covered by the standard (traditional) diets in Ghana and Benin, and the contributions of partial breastfeeding and national nutrition programs aimed at improving micronutrient status to overall micronutrient intakes. Estimates of micronutrient intake from standard diets were based on previous surveys, using the food composition table of West Africa (INFOOD). Recommended micronutrient intakes were based on World Health Organization recommendations. Children were grouped in three age groups (6-8, 9-12, and 13-24 months) to capture the changing dynamics of the complementary feeding period. As expected, from 6 months of age onwards, breastmilk didn't cover the micronutrient needs. The standard diets contributed only minimal to micronutrient intakes of children ranging from 0% to 37% of recommended intakes for Ca, Fe, Zn, vitamin A, vitamin D and iodine depending on the micronutrient considered. The contribution of mass (bio)-fortification programs to the coverage of micronutrient needs varied widely, depending on the staple food considered and the country, but overall did not allow to fill the gap in micronutrient needs of children except for vitamin A in some contexts. In contrast, consumption of voluntary fortified complementary food, especially formulated for the needs in this age groups, contributed substantially to overall micronutrient intake and could fill the gap for several micronutrients. The development of young child-targeted programs including micronutrient-dense foods, associated with interventions to increase the diet diversity and meal frequency, could significantly improve micronutrients intakes of children in both Ghana and Benin.

Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6-23 months)? Evidence from JEEViKA in Rural Bihar, India

OBJECTIVES

Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups.

METHODS

The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6-23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase.

RESULTS

During the pre-intervention phase, 19% of the children (6-23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events.

CONCLUSION

BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.

Minimum acceptable diet and its associated factors among children aged 6–23 months in Lalibela, northeast Ethiopia: a community-based cross-sectional study

The first 2 years of life are a critical window of opportunity for ensuring optimal child growth and development. In Ethiopia, the magnitude of the minimum acceptable diet ranges from 7 to 74⋅6 %. The evidence revealed the variation and unrelated data on the prevalence of minimum acceptable diet. Therefore, the present study aimed to assess the minimum acceptable diet and its associated factors among children aged 6–23 months in Lalibela town administration, northeast Ethiopia. A community-based cross-sectional study was conducted in Lalibela town administration, northeast Ethiopia among 387 mothers/caregivers with children aged 6–23 months from May 1 to 30, 2022. The data were entered by Epidata version 3.1 and analysed by SPSS version 25.0. A multivariable binary logistic regression model was fitted to identify factors associated with minimum acceptable diet. The degrees of association were assessed using an adjusted odds ratio with a 95 % confidence interval and P-value of 0⋅05. The magnitude of minimum acceptable diet in the study area was 16⋅7 % (95 % confidence interval: 12⋅8–20⋅6 %). Sex of child, getting infant and young child feeding counselling at antenatal care, infant feeding practice-related knowledge and childhood illness are the variables that were found to be an independent predictor of minimum acceptable diet. Health facilities should strengthen infant feeding counselling starting from antenatal care visits during pregnancy for the recommended minimum acceptable diet is crucial.

Correlates of dietary diversity among children aged 6-23 months of head porters in Ghana

Objective

In many developing countries, most children cannot meet minimum dietary diversity (MDD), defined as the consumption of four or more of the seven food groups. In Ghana, only 35% of children met MDD nationwide in 2017, but rates are worse among the rural poor and resource-constrained individuals like Head Porters (HPs). The current study investigated the correlates of MDD in children of HPs aged 6-23 months old in Ghana.

Methods and materials

A cross-sectional survey was carried out in 2021 among 423 HPs selected purposively from eight market centers in two commercial cities. A multi-stage sampling method was used in obtaining the sample, while a structured interview guide was used to collect data from the caregivers. Stata version 15.1 and descriptive and inferential statistics like frequency, percentage, chi-square and logistic regression were used to analyze the data. All results were deemed significant if the p-value was < 0.05 and the odds ratios with a 95% confidence interval.

Results

The children had a mean age of 14.3 (±4.9) months, while half of the caregivers (48.2%) were between 15 and 25 years. Approximately 59% (251) had good knowledge of infant and young child feeding practices (IYCF). About 45% of the children consumed a diversified diet. The number of postnatal care (PNC) visits, delivery in a health facility, meeting minimum meal frequency (MMF), and the child's age was independently associated with MDD at the multivariate level.

Conclusion

Over a third of the caregivers had poor knowledge of IYCF practices. Furthermore, less than half of the children achieved MDD reflecting the need for more education by the stakeholders. Regular PNC visits and delivery in health facilities were independently associated with MDD; therefore, interventions to combat low MDD should prioritize the relevance of these predictors.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Complementary Feeding Practices and Household Food Insecurity Status of Children Aged 6–23 Months in Shashemene City West Arsi Zone, Oromia, Ethiopia

Introduction

Appropriate infant feeding practices are critical to a child's growth, health, and development during the first 1000 days of life. One in every six children worldwide receives a minimum acceptable diet. According to the EDHS 2016, the status of the minimum acceptable diet was 7 percent among children aged 6–23 months in Ethiopia. The study sought to ascertain the relationship between complementary feeding (CF) indicators and household food insecurity in children aged 6–23 months.

Methods

A systematic sampling method was used to conduct a cross-sectional study of 536 mother-child pairs aged 6–23 months. The 24-hour dietary recall was used to collect data on CF practices using face-to-face interviews with socioeconomic and food security questionnaires. The relationship between complementary feeding indicators and household food insecurity was investigated using logistic regression analysis. The relationship between independent variables and complementary feeding indicators was determined using multivariate logistic regression.

Results

Overall, a total of 67.9% of children received timely introduction of CF and Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), and Minimum Acceptable Diet were met by 61.7%, 42.5%, and 41.7%, respectively. Result of multivariate logistic regression showed there is significant association between household food security with MMF, MDD, and MAD [AOR: 2.02, 95% CI: (1.25–3.24); AOR: 1.55, 95% CI: (1.02–2.36); and AOR: 1.62, 9595% CI: (1.06–2.47)], respectively, while there was no association with introduction of CF [AOR = 0.87, 95% CI: (0.55–1.39)].

Conclusion

This study revealed that the rates of MMF, MDD, and MAD remained low in this study setting. Household socioeconomic status (wealth index, food security status, household income) and child age were found to be among the factors statistically significantly associated with complementary feeding practices indicators.

Trends in Complementary Feeding Indicators and Intake from Specific Food Groups among Children Aged 6-23 Months in Bangladesh

The present study aims to comprehensively analyse trends in complementary feeding indicators (Introduction of solid, semi-solid, and soft foods at 6–8 months (INTRO), Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD)) among children aged 6–23 months in Bangladesh. The study used data from four rounds (2007, 2011, 2014, and 2017–2018) of nationally representative Bangladesh Demographic and Health Surveys (BDHSs). The Cochran–Armitage test was performed to capture the trends in complementary feeding practices and intake from specific food groups. BDHSs are periodically conducted cross-sectional surveys in all seven administrative divisions of Bangladesh. The present analysis was performed among 8116 children (1563 in 2007, 2137 in 2011, 2249 in 2014, and 2167 in 2017–2018) aged 6–23 months. Overall, a decreasing trend was observed in all the complementary feeding indicators except INTRO from 2007 to 2014, but a substantial increase in MDD, MMF and MAD was noted in 2017–2018. A statistically significant reduction in consumption from different food groups such as legumes and nuts (p < 0.001), dairy products (p = 0.001), vitamin-A-rich fruits or vegetables (p < 0.001), and other fruits and vegetables (p < 0.001) was also observed. However, a positive trend was noted in the consumption of grains/roots/tubers (p = 0.027), and meat/fish/egg (p < 0.001). After experiencing a significant decreasing trend during 2007–2014, the recent BDHS indicates improvements in all complementary feeding indicators among young children in Bangladesh, which calls for integrated, multisectoral, and multicomponent interventions to sustain this progress.

Evaluation of mother's complementary feeding knowledge and occlusion

Aim:

Mothers' understanding of feeding methods and how they affect deciduous dentition were the focus of this study.

Materials and Methods:

This study looked at people from different parts of the population. In total, 230 moms of children aged 6 months to 5 years who completed an oral health questionnaire were included in the study. Mothers' awareness of feeding patterns and their impact on deciduous dentition were examined in the study.

Results:

Illiterate moms' children showed a significant difference in the quality of their occlusion compared to similarly raised children of literate mothers. Children who began supplementary feeding before the age of 6 months were more likely to have occlusion changes.

Conclusion:

Malocclusion prevalence was shown to be unrelated to meal behaviors. However, further research is required as there are just a few studies currently available.

Minimum dietary diversity and its associated factors among infants and young children in Ethiopia: evidence from Ethiopian Demographic and Health Survey (2016)

Background

Adequate infant and young child feeding during the first 1000 days of life is very essential to improve child health, survival, growth, and development through minimum dietary diversity (MDD). Hence, this study aimed to assess MDD and its multi-level factors among infants and young children aged 6–23 months in Ethiopia.

Methods

Ethiopian Demographic and Health Survey (EDHS-2016) data was used to identify both individual and community-level factors of dietary diversity. Weighted samples of 2,962 children were eligible and a multi-level regression model was used for the analysis. Finally, factors with a P-value of <0.05 were considered statistically significant.

Results

The prevalence of MDD among children in Ethiopia was 12.09%. According to this study, factors such as having a mother who attended higher education (AOR = 3.09, (95% CI; _1.67–5.71)), being a female household head (AOR = 0.62, (95% CI; _0.40–0.95)), having a mother's agricultural occupation (AOR = 1.89, (95% CI; _1.10–3.23)) and living in the household in the richest wealth index were significantly associated at the individual level. At the community level, children living in rural areas (AOR = 0.62, 95% CI; 0.39–0.98) were significant risk factors for MDD (AOR = 0.62, 95% CI; 0.39–0.98).

Conclusion

The educational and occupational status of the mother, wealth index, and region were significantly associated with MDD. Hence, strengthening of the existing nutritional intervention is helpful to increase diversified food consumption among children.

Predictors of complementary feeding practices among children aged 6-23 months in five countries in the Middle East and North Africa region

Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low- and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A complementary food supplement from local food ingredients to enhance iron intake among children aged 6-59 months in Benin

Nutritious complementary feeding is often not affordable in Benin, and iron deficiency exists. This research aimed at formulating an affordable and sensory acceptable complementary food supplement using local food ingredients to increase iron intake among children aged 6-59 months in Benin. The complementary food supplement was formulated to ensure that 10 g would cover 25% of the estimated average requirements for iron for children aged 6 to 12 months. Adansonia digitata fruit pulp, Moringa oleifera leaf powder, and Cochlospermum tinctorium root powder were used to compose the complementary food supplement, which was mixed with maize and sorghum ogi porridges before being presented to the mothers and children for the acceptability test. The mineral contents of Adansonia digitata fruit pulp in mg/100 g dw were 9.9 ± 0.1 for iron and 0.9 ± 0.1 for zinc. The iron and zinc contents of Moringa oleifera leaf powder and Cochlospermum tinctorium root powder in mg/100 g dw were 34.1 ± 2.2 and 26.8 ± 2.7 and 9 ± 0.0 and 0.9 ± 0.0, respectively. The complementary food supplement contained, in mg/100 g dw, 17.4 ± 1.1 of iron and 1.2 ± 0.1 of zinc. The maize and sorghum ogi porridges enriched with the complementary food supplement at substitution rates of 15% and 16% (in dry weight), respectively, were acceptable to 85% of children for sorghum ogi porridge and 87% for maize ogi porridge. The present study demonstrated the potential of local food ingredients in the formulation of an iron-rich and acceptable complementary food supplement for children aged 6-59 months in Benin.

Complementary feeding practices and associated factors of dietary diversity among uncomplicated severe acute malnourished children aged 6-23 months in Burkina Faso

Nutritional treatment of children with uncomplicated severe acute malnutrition (SAM) is based on ready‐to‐use therapeutic foods (RUTF). With treatment provided at community level, children could have access to other foods, and a reduction in the dose of RUTF could further increase dietary diversity during treatment. We assessed the dietary diversity score (DDS), the minimum dietary diversity (MDD), the minimum meal frequency (MMF) and the minimum acceptable diet (MAD) of 459 infants and young children aged 6–23 months being treated for SAM with different doses of RUTF. We also investigated the factors associated with DDS. Dietary intake was estimated using a single 24‐h multipass dietary recall, 1 month after starting treatment, from December 2016 to August 2018. The DDS was calculated on the basis of eight food groups. Differences between children receiving the reduced RUTF and the standard RUTF dose and factors associated with DDS were assessed by Poisson and logistic regression models. RUTF dose was not associated with DDS (4.07 ± 1.25 for reduced RUTF and 4.01 ± 1.26 for standard RUTF; P = 0.77). Food groups most consumed by children were grains, roots or tubers (96%) and legumes and nuts (72%). Eggs consumption was low (3%). DDS was positively associated with child's age, mother's education, household wealth index, urban residence and rainy season. The present findings show that children with SAM consumed a variety of foods during treatment in addition to the RUTF ration prescribed to them. Reducing the dose of RUTF during SAM treatment did not impact DDS.

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.

Socioeconomic and Geographic Pattern of Food Consumption and Dietary Diversity among Children Aged 6-23 Months Old in Ghana

Dietary inadequacy is a major challenge among young children in Ghana. Nutritional policies are required for optimum child nutrition and development. This study explored food consumption and dietary diversity by socioeconomic status and geographical location among children aged 6–23 months in Ghana. We used the latest national representative, cross-sectional data from the Ghana Demographic and Health Survey (GDHS-2014). A total of 887 children aged 6–23 months were used in the final analysis. The survey collected data on children’s food consumption through their mothers in the 24 h recall method. Multiple logistic regression models were used to assess the relationship between socioeconomic status and geographical location with food consumption and adequate dietary diversity after adjusting for control variables. The study revealed an association between specific food item consumption, food groups, and dietary diversity by socioeconomic and geographic characteristics. However, dairy consumption increased faster than other nutritional foods when socioeconomic status increased. Furthermore, the study revealed that children’s chances of consuming particular food items and food groups differed across Ghana’s 10 regions. The average probabilities of consuming adequate dietary diversity between the Greater Accra region and Ashanti region were 43% vs. 8% (p < 0.001). Consumption of grains, root, and tubers were relatively higher but low for Vitamin A-rich fruits and vegetables and legumes and nuts for children aged 6–23 months in Ghana. Overall, the mean dietary diversity score was low (3.39; 95% CI: 3.30–3.49) out of eight food groups, and the prevalence of adequate dietary diversity was 22% only. There is a need for policy interventions to ensure appropriate dietary practices to promote healthy growth of children.

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).

Unintended consequences of programmatic changes to infant and young child feeding practices in Bangladesh

BRAC, an international development organization, implemented a home-fortification programme from 2014 to 2018 in Bangladesh. This study aimed to understand the unintended consequences of programmatic changes that occurred during the implementation of the programme on the prevalence of good infant and young child feeding (IYCF) practices and other associated factors. We used pooled data from eight cross-sectional surveys and data from a series of qualitative investigations carried out as part of a mixed-methods evaluation approach. A total of 6,479 caregivers of children aged 6 to 23 months participated in the surveys. The prevalence of good IYCF practices increased from baseline (42.1%) to midline (45.3%), but it decreased at the endline survey (31.9%). Qualitative investigations identified several reasons for low IYCF practices at the programme level, such as the withdrawal of community health worker (CHW) incentives for promoting IYCF, providing incentives for the home-fortification of micronutrient powder (MNP) and changing the focus from IYCF promotion to MNP promotion. A multivariable generalized estimating equation model for pooled data revealed that caregivers were 28% (adjusted risk ratio [ARR]: 0.72, 95% CI [0.67, 0.78]) less likely to maintain good IYCF practices during the period when CHWs were not incentivized to promote IYCF compared to the period when CHWs were incentivized to promote it. The prevalence of good IYCF practices decreased from both baseline and midline to the endline survey due to the unintended consequences of the programmatic changes. An integrated intervention strategy to promote the home-fortification of MNP and IYCF could be helpful to avoid unintended negative consequences of programmatic changes.

Maternal Characteristics Are Associated with Child Dietary Diversity Score, in Golina District, Northeast Ethiopia: A Community-Based Cross-Sectional Study

Background

Dietary diversity is part of the set of indicators developed to assess infant and young child feeding practices. In developing countries, only a quarter of children met the required minimum dietary diversity. In Ethiopia, only 14% of children aged 6–23 months met the minimum dietary diversity score, with regional variation. Therefore, this study aimed to assess dietary diversity score and associated factors among children aged 6–23 months in Golina district, Afar region, Ethiopia.

Method

A community-based cross-sectional study was conducted among 345 study participants from February 15 to March 30, 2017, in Golina district, Afar, Northeast Ethiopia. The study kebeles were selected randomly and the study subjects were selected using a cluster sampling technique. The child dietary diversity score was determined by the WHO child dietary diversity score scale, using a 24-hour dietary recall method, and data were collected using an interviewer-administered questionnaire. Multivariable logistic regression was used to identify predictor variables, and the level of significance was determined at P value <0.05.

Result

This study revealed that children who met the required minimum dietary diversity score were 35.1% (95% CI, (30%–40%)). Children whose mothers have not attended formal education were 3.042 times (AOR = 3.042 95% CI: (1.312–7.052)) less likely to meet the minimum dietary diversity score than children whose mothers have attended secondary and above. Children whose mothers had normal BMI were 51.2% (AOR = 0.488, 95% CI: (0.259–918)) and 68.1% (AOR = 0.319, 95% CI: (0.119–0.855)) more likely to meet the minimum dietary diversity score than children whose mothers' BMI was underweight and overweight, respectively.

Conclusion

Maternal characteristics (educational status and nutrition status) were found to be associated with their child's dietary diversity score. This study also revealed that children who met the minimum dietary diversity score were few. Therefore, the increased emphasis on the importance of the education of girls (future mothers) and nutrition counseling for girls/women who currently have received little education on ways to improve the family and child dietary feeding practice is needed.

Feeding practices in 6-24-month-old children with chronic cholestatic liver diseases: a mixed-method study

Background

Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management in China has received little attention, and there has been limited evidence regarding improving these practices. This study aimed to evaluate the feeding status of chronic cholestatic children aged 6–24 months and to explore their parents’ experiences with feeding practices.

Methods

A mixed-method study was conducted among parents of 74 children with chronic cholestatic liver diseases. The Infant and Young Child Feeding Index (ICFI) was used to collect quantitative data of feeding practices. In-depth interviews with parents were performed to generate qualitative data. Multivariate analysis was conducted to identify predictors of inappropriate feeding practices. Qualitative data were analyzed using thematic analysis.

Results

Only 16.2% of the children had appropriate feeding practices. In terms of dairy products, the rate of breastfeeding, medium-chain triglyceride formula feeding, and regular formula feeding were 25.7, 39.2 and 44.6% respectively. The complementary feeding rate was 68.8%, and the age of adding complementary foods was 6.9 ± 1.7 months. Consumption of foods from animal sources was suboptimal, 66.7% of the children aged 6–8 months and 45.5% of the children aged 9–11 months had carbohydrates as a single source of complementary foods and had no intake of meat, eggs or bean products, while in the age group 12–24 months, 52.0% of the children had eggs less than 2 days/week, 60.0% had meat less than 2 days/week, and 60.0% had no intake of bean products. Low literacy of the primary care provider was significantly related to inappropriate feeding practices (adjusted OR 5.52; 95% CI 1.29, 23.66). The result of the interviews indicated that parents generally lacked the scientific knowledge of feeding and thought that the intake of animal source foods and oils would be a burden to the liver and cause damage to the liver functions.

Conclusion

Parents generally lacked science-based feeding knowledge and the feeding practices in 6–24-month-old children diagnosed with chronic cholestatic liver diseases fell short of the recommendations in current nutritional guidelines. Appropriate interventions targeting social and cultural family circumstances should therefore be included in supporting parents in feeding practices to improve children’s clinical outcomes.

Dietary Diversity and Associated Factors among Children Aged 6-59 Months in Ethiopia: Analysis of Ethiopian Demographic and Health Survey 2016 (EDHS 2016)

Background

Dietary diversity is one of the key elements of diet quality. Even though different measures were taken to increase dietary diversity feeding practice in Ethiopia, the problem still remains high. Therefore, this study was done to identify determinants of inadequate minimum dietary practice among children aged 6-59 months in Ethiopia.

Method

Secondary analysis of the data from the 2016 Ethiopian Demographic and Health Survey was done on a weighted sample of 5161 children aged 6-59 months. Data analysis was done using STATA v.14. Variables with P value < 0.05 in the bivariable analysis were candidates for the multivariable analysis to identify independent determinants of dietary diversity. Odds ratios (OR) were calculated at 95% confidence interval (CI).

Results

A total of 5161 children aged 6 to 59 months were enrolled in the study. Only 8.5% of the children had the recommended minimum dietary diversity. Mother's education (adjusted odds ratio (AOR) = 2.51 (1.65, 3.83)), mothers currently working (adjusted odds ratio (AOR) = 1.83 (1.47, 2.29)), mother's wealth index (adjusted odds ratio (AOR) = 4.75 (3.31, 6.81)), age of a child (adjusted odds ratio (AOR) = 1.72 (1.24, 2.39)), and number of under-five children (adjusted odds ratio (AOR) = 1.49 (1.12, 2.00)) were significantly associated with the minimum dietary diversity.

Conclusion

The minimum dietary diversity was not achieved by most children 6-59 months of age in Ethiopia. Ensuring large-scale interventions that focus on the identified factors should be considered by concerned bodies to improve the dietary diversity practice.

Sustainable under nutrition reduction program and dietary diversity among children's aged 6-23 months, Northwest Ethiopia: Comparative cross-sectional study

INTRODUCTION

Adequate dietary diversity is vital for the survival, growth and development of infants and children. Inadequate dietary diversity is the major cause of micronutrient deficiency in Sub-saharan Africa, including Ethiopia, where only less than one-fourth of the children aged 6-23 months obtain adequate diversified diet. Thus country implemented a strategy known as the Sustainable Undernutrtion Reduction (SUR) programs to alleviate the problem. However, empirical evidences are scarce on the impact of the program on children aged 6-23 months. Therefore, this study aimed to compare the level of dietary diversity among children aged 6-23 months in districts covered and not covered by SURE program in West Gojjam zone.

METHODS

A community based comparative cross-sectional study was conducted in three districts of West Gojjam zone, Ethiopia, from February 29 to April 20, 2019. A total of 832 mother and child pairs were selected by the simple random sampling technique. A pretested and structured interviewer-administered questionnaire was used to collect data. A binary logistic regression model was fitted to identify factors associated with dietary diversity. Crude odds and adjusted odds ratios with 95% confidence intervals (CI) were calculated to assess the strength of associations and significance of the identified factors for dietary diversity score.

RESULT

The overall proportion of adequate dietary diversity among children aged 6-23 months was 29.9% (95% CI: 27.0-33.0), whereas in SURE covered and uncovered districts it was 33.4% (95%CI: 29.0-38.and 26.4%(95% CI: 22.0, 31.0), respectively. ANC (Antenatal care) (AOR = 1.7; 95% CI: 1.16, 2.55) and postnatal care services (AOR = 2.1; 95% CI: 1.38, 3.28), participating in food preparation programs (AOR = 1.9; 95% CI: 1.19, 2.96), GMP (AOR = 2.74,95%CI:1.80, 4.18), vitamin A supplementation (AOR = 2.10,95%CI:1.22, 3.61) and household visits by health extension workers (AOR = 2.0; 95% CI: 1.25, 3.21) were significantly associated with dietary diversity.

CONCLUSION

The proportion of adequate dietary diversity was higher among children in the program than those out of the program. ANC visits, PNC follow-ups, women's participating in food preparation programs and household visits by health extension workers were significantly associated with dietary diversity. Therefore, and strengthening and scaling up the program to non covered districts and providing health and nutrition counseling on Infant and Young Child Feeding (IYCF) during ANC and PNC services are recommended for achieving the recommended dietary diversity.

Minimum Meal Frequency Practice and Its Associated Factors among Children Aged 6-23 Months in Amibara District, North East Ethiopia

Background

Minimum meal frequency, a proxy indicator for a child's energy requirements, examines the number of times children received foods other than breast milk. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and increased morbidity and mortality. In Ethiopia, only 45% of children had fed with an age-appropriate minimum meal frequency.

Objective

The study was aimed to assess the minimal meal frequency practice, and its associated factors among children aged 6–23 months in Amibara district, North East Ethiopia.

Methods

A community-based cross-sectional study was conducted from May 07–May 23, 2018. Systematic random sampling technique was applied to select 367 children aged 6–23 months. The univariable and multivariable binary logistic regression analyses model was used to identify potential predictors of meeting minimum meal frequency. All variables with P values <0.25 in the univariable analysis were taken to multivariable analysis, and variables at P values <0.05 were considered as statistically significant.

Results

The study revealed a prevalence of minimum meal frequency 69.2% (95% CI: 0.64–0.74). Timely initiation of breastfeeding (AOR = 2.2, 95% CI (1.17, 4.18)), current breastfeeding status (AOR = 7.5, 95% CI (3.95, 14.4)), meeting minimum dietary diversity (AOR = 3.7, 95% CI (1.85, 7.44)), and household hunger scale (AOR = 5.3, 95% CI (1.5, 12.5)) were some of the significant predictors to achieve minimum meal frequency.

Conclusion

The prevalence of minimum meal frequency practice is low in the study area. Current breastfeeding status, timely initiation of breastfeeding, no/little household hunger scale, and meeting minimum dietary diversity were found as significant predictors for minimum meal frequency practice. Mothers having children aged 6–23 months should be aware and practice appropriate infant and young child feeding practices including timely initiation of breastfeeding, breastfeeding till the child celebrate his/her second birthday, recommended meal frequency, and dietary diversity practice. In addition, households should be assessed and strengthened for food security.

Maternal determinants of optimal breastfeeding and complementary feeding and their association with child undernutrition in Malawi (2015-2016)

BACKGROUND

Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting.

METHODS

The most recent Malawi Demographic Health Survey (2015-2016) was used and data for 2294 children aged 0-23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women's empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p-value of < 0.05 were considered significant in the final model.

RESULTS

Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13-23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight.

CONCLUSIONS

Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil

OBJECTIVE

To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors.

METHODS

A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers' and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake.

RESULTS

The prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08-2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01-2.27]) were factors associated with the consumption of ultra-processed foods.

CONCLUSIONS

High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.

Effectiveness of an Educational Manual to Promote Infant Feeding Practices in Primary Health Care

OBJECTIVE

To test the hypothesis that a continuing educational strategy (ie, "the manual") in primary health-care improves infant feeding practices among infants under 1 year of age.

METHODS

A before and after study was conducted at primary health-care units in Embu das Artes, Brazil. The intervention was the use of a manual created to support continuing educational activities on breastfeeding and complementary feeding to be performed by tutors of Estratégia Amamenta e Alimenta Brasil with health-care teams, in a period of 8 months. Five hundred sixty-one mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis.

RESULTS

Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices.

CONCLUSIONS

The manual is a continuing educational strategy that improved complementary feeding practices in primary health care.

Maternal Factors and the Utilization of Maternal Care Services Associated with Infant Feeding Practices among Mothers in Rural Southern Nepal

This study aimed to investigate the maternal factors and utilization of maternal care services associated with infant feeding practices in rural areas of Southern Nepal. Data from a cluster randomized controlled trial 'MATRI-SUMAN'(Maternal Alliance for Technological Research Initiative on Service Utilization and Maternal Nutrition) conducted between 2015-2016 were analyzed. A total of 426 pregnant women in their second trimester were recruited from the MATRI-SUMAN trial, which was conducted on six villages in rural areas of the Dhanusha district, Nepal. A total of 379 mothers that had ever breastfed their infants, and followed for at least seven months after birth were included in the analysis. Multivariate logistic regression analysis was used to identify independent risk factors associated with child feeding practices after controlling for potential confounders. Of the 379 mothers, 41.4%, 53%, and 43% initiated breast feeding within the first hour of birth (EIBF), practiced exclusive breastfeeding (EBF), and initiated timely complementary feeding (CF) at six months, respectively. Multiple logistic regression results revealed that maternal education (secondary or higher), an occupation in the service/business/household sectors, receipt of MATRI-SUMAN intervention, more than four ANC (antenatal care) visits, and delivery in a health facility were associated with higher odds ratios of EIBF. Similarly, mothers with a primary, secondary and higher level of education, that worked in the service/business/household sectors, primiparous mothers, those that received MATRI-SUMAN intervention, visited ANC more than four times, and made a PNC (postnatal care) visit had higher odds ratios of EBF, while mothers who were 35-45 years of age were less likely to have used EBF. In addition, education to the secondary or a higher level, a male baby, receipt of MATRI-SUMAN intervention and a PNC visit had higher odds ratios of CF initiation at six months. The promotion of maternal ANC visits, birth at a health institution, and postnatal visits should be recommended in order to improve child feeding practices in Nepal.

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.

Stunting and severe stunting among infants in India: the role of delayed introduction of complementary foods and community and household factors

Background: Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and associated factors are related to stunting and severe stunting among children in many low- and middle-income countries. In India, however, there is limited evidence on the relationship between delayed complementary feeding and associated factors with stunting and severe stunting to advocate for policy interventions. Objectives: The present study investigated the relationship between delayed complementary feeding and associated factors with stunting and severe stunting among infants aged 6-8 months in India. Methods: Survey data on 13,548 infants aged 6-8 months were obtained from the 2015-16 National Family Health Survey in India. Logistic regression (Generalized Linear Latent and Mixed Models [GLLAMM] with a logit link and binomial family) models that adjusted for clustering and sampling weights were used to investigate the relationship between delayed complementary feeding and associated factors (community, household, maternal, child and health service factors) with stunting and severe stunting among infants aged 6-8 months in India. Results: The prevalence of stunting and severe stunting was 22.0% (95% CI: 21.0-23.7%) and 10.0% (95% CI: 9.0-11.0%) among infants aged 6-8 months who received no complementary foods, respectively. Delayed introduction of solid, semi-solid or soft foods was associated with stunting (adjusted Odd ratios [aOR] = 1.24, 95% CI: 1.09-1.41) and severe stunting (aOR = 1.21, 95% CI: 1.01-1.45) among infants aged 6-8 months. High maternal education (secondary or higher education) and household wealth (middle, richer and richest) were protective against stunting and severe stunting. Conclusion: Delayed introduction of complementary foods and associated factors were related to stunting and severe stunting among infants aged 6-8 months in India. Reducing the proportion of infants who are stunted in India would require comprehensive national nutrition policy actions that target the sub-population of mothers with no schooling and limited resources.