Determinants of inappropriate complementary feeding practices in young children in Sri Lanka: secondary data analysis of Demographic and Health Survey 2006-2007

Trend and determinants of minimum dietary diversity consumption change among children aged 6-23 months in Ethiopia from 2011 to 2019: A multivariate decomposition analysis

BACKGROUND

Sustainable Development Goals 2 target 2.2 aimed to end all forms of malnutrition by 2030. However, the prevalence of inadequate minimum dietary diversity (MDD) is high in Ethiopia and the evidence of trends and determinants of MDD consumption change among children over time is limited. Therefore, this study aimed to determine trends and determinants of MDD consumption change among children aged 6 to 23 months in Ethiopia from 2011-2019 Demographic and Health Survey (DHS) data.

METHOD

The study used the data on nationally representative weighted samples of 6,971, 7,467, and 3,154 children aged 6-23 months from the 2011, 2016, and 2019 rounds of the DHS. Trend and Multivariate Decomposition analysis was conducted to determine MDD consumption change from 2011-2016, and 2016-2019 into two components: one that was explained by differences in the level of the determinants (endowment), and the other component was explained by differences in the effect of the covariates on the outcome (coefficient effects).

RESULT

The trends analysis showed that adequate MDD consumption significantly increased from 2% to 10.41% from 2011 to 2016 but decreased from 10.41% to 7.11% from 2016 to 2019 in Ethiopia. The compositional and behavioral change factors like maternal age, occupational status of parents, sex of the household head, wealth index, residence, and sex of child statistically contributed to changes in MDD consumption from 2011 to 2016, and from 2016 to 2019 at p-value <0.05.

CONCLUSION

The trend of minimum dietary diversity consumption among children aged 6 to 23 months in Ethiopia increased from 2011-2016 and decreased from 2016-2019 in the last decade. The study revealed that the changes in behavioral response and population composition contributed to MDD consumption change among children in Ethiopia. The finding highlights the urgent need for targeted interventions and policies to address the issue of MDD consumption change among young children due to population structure changes like wealth status, residence, and behavioral response related to employment, household head, and sex of the child in Ethiopia. Therefore, efforts should be geared to reduce poverty and improve maternal employment status, particularly for women, by producing equitable economic opportunities.

Spatial distribution of inadequate meal frequency and its associated factors among children aged 6-23 months in Ethiopia: Multilevel and spatial analysis

INTRODUCTION

More than two-third of global child death is occurred due to inappropriate feeding practice that happened during early childhood period. Evidence on meal frequency status among infant and young children at national level can be used to design appropriate interventions to improve the recommended feeding frequency. Therefore, this study was aimed to explore the spatial distribution and identify associated factors of inadequate meal frequency among children aged 6-23 months in Ethiopia.

METHODS

Secondary data analysis was conducted using the 2019 mini Ethiopian Demographic and Health Survey data. A total weighted sample of 1,532 children aged 6-23 months were included. To identify significant factors associated with of inadequate meal frequency, multilevel binary logistic regression model was fitted. Variables with p-value < 0.25 from the bi-variable model were exported to multivariable analysis. In the multivariable model, variables with p-value < 0.05 were declared as significantly associated factors and adjusted odds ratio (AOR) with its 95% confidence interval were reported. Multilevel models were compared using deviance and log-likelihood. Spatial analysis tools were utilized to visualize the distribution of inadequate meal frequency. Bernoulli model was fitted using SaTScan V.9.6 to identify most likely clusters and ArcGIS V.10.8 was used to map the hotspot areas. Ordinary least square and geographic weighted regression models were used and compared using information criteria and adjusted-R2. Local coefficients of factors associated with hotspots of inadequate meal frequency were mapped.

RESULTS

The prevalence of inadequate meal frequency was 47.03% (95% CI: 44.54%, 49.53%) in Ethiopia. Age of the child, sex of the household head, timely initiation of breastfeeding, current breastfeeding status, number of antenatal care visit, maternal education, and region were significantly associated with inadequate meal frequency. The spatial distribution of inadequate meal frequency was showed significant variation across Ethiopia (Global Moran's I = 0.164, p-value <0.001). A total of 38 significant clusters were detected through SaTScan analysis, from these the 22 primary clusters were located in Somali and Harari.

CONCLUSION AND RECOMMENDATION

The prevalence of inadequate meal frequency was high in Ethiopia and had significant clustering patter. Significant hotspot clusters were located in Somali, northern Afar, Harari, Amhara, Gambela, and eastern South nation nationalities and peoples' region. Therefore, public health interventions which enhance breastfeeding practice, optimal number of antenatal care visits, educational empowerments should target hotspot areas to decrease inadequate meal frequency practice.

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.

Complementary Feeding for Children Aged 6-24 Months: Impact and Maternal Awareness in Al Baha City, Saudi Arabia

Background Breastfeeding and complementary feeding are essential for baby health and nutrition. Concerning these feeding habits, there is a dearth of information on mother awareness and behaviors in Saudi Arabia. This study intends to evaluate maternal knowledge of breastfeeding and complementary feeding in Al Baha City, Saudi Arabia. Methodology This cross-sectional prospective study was conducted among mothers in Al Baha City, Saudi Arabia. Data were collected using a structured electronic questionnaire and analyzed using descriptive statistics and a chi-square test. Results We received 524 responses. The majority of participants (358, 68.2%) were found to have sufficient understanding of breastfeeding and complementary feeding. Four hundred and forty participants (84%) were aware that breastfeeding should begin immediately after birth, but only 250 (47.7%) participants knew the proper time to start complementary feeding. Three hundred and ninety-six (75.6%) participants were aware of the proper duration of exclusive breastfeeding, whereas 128 (24.4%) of them did not know. The study showed that factors such as occupation, family economic status, and educational level influence maternal knowledge of complementary feeding.  Conclusions The study revealed that the majority of participants had good knowledge about breastfeeding and complementary feeding. The study highlights effective training and public awareness initiatives aimed at improving mothers' knowledge and practices regarding feeding. Additionally, it sheds light on the healthcare providers' exemplary knowledge and attitudes toward appropriate feeding practices among mothers in Al Baha City.

The influence of dietary diversity on anthropometric status among young children ages 12 and 24 months in Wuhan, China

The relative research on investigating the association between dietary diversity scores and anthropometric status among young children is few and inconsistent. Since understanding this association is quite essential to give more detailed advice about diet to ensure young children's healthy growth, we sought to determine the association between dietary diversity levels and anthropometric status among young children under 24 months. The study included 1408 mother-child pairs from the Tongji Maternal and Child Health Cohort, whose children range in age from 12 to 24 months. Multivariable logistic regressions were used to examine the effect of dietary diversity on children's anthropometric failure and obesity. All obese children aged 12 and 24 months had low-medium diverse diets in their first year of life. Risks of anthropometric failure for 12-month young children consumed low-medium diverse diets in their first year and 24-month young children consumed low-medium diverse diets in their second year are, respectively, 1.27 (odds ratio [OR], 95% confidence interval [CI] = [1.06-1.53]) and 1.19 (OR, 95% CI = [1.02-1.40]) times of those who consumed high diverse diets in corresponding year. The risk of anthropometric failure for 24-month-old children who consumed low-medium diverse diets during their first year of life is 4.70 (OR, 95% CI = [1.62-19.91]) times that of young children who consumed highly diverse diets during their first year of life. Introducing more diverse diets to young children under 24 months of age may be an effective strategy to prevent anthropometric failure and obesity in young children in later life.

Association of dietary diversity of 6-23 months aged children with prenatal and postnatal obstetric care: evidence from a nationwide cross-sectional study

BACKGROUND

Dietary diversity is a key determinant of infant and young child eating patterns for a variety of food groups taken by children between the ages of 6-23 months. The study aimed to examine the association between prenatal and postnatal obstetric care factors of mother and child's dietary diversity, and specific food practices in Bangladesh.

METHODS

This study analyzed the data of 2497 children between the age of 6-23 extracted from the latest countrywide Bangladesh Demographic Health Survey 2017-2018 and explored relationships between prenatal and postnatal obstetric care received by mother and dietary diversity score (DDS), minimum dietary diversity (MDD), and introduction of solid, semi-solid, and soft foods (ISSSF) of their children.

RESULTS

Findings revealed that ≥ 4 antenatal care (ANC) visits care visits increased the DDS (adjusted [Formula: see text]: 0.32, 95% CI [0.21, 0.43]), increased the likelihood of MDD (AOR 1.54, 95% CI [1.23, 1.93]), and ISSSF (AOR 1.24, 95% CI [1.08, 1.48]), consuming eggs (AOR 1.47, 95% CI [1.23, 1.76]), and vitamin A vegetables and fruits (AOR 1.38, 95% CI [1.15, 1.66]). Moreover, DDS (adjusted β: 0.05, 95% CI [0.00, 0.11]) and MDD (AOR 1.66, 95% CI [1.31, 2.11]) are linked to childbirth in a medical facility. The C-section delivery influences the DDS (adjusted [Formula: see text]: 0.05, 95% CI [0.00, 0.10]), MDD (AOR 1.39, 95% CI [1.10, 1.75]), and ISSSF (AOR 1.22, 95% CI [1.02, 1.48]). Besides, postnatal visits within 48 h of delivery linked to MDD (AOR 0.66, 95% CI [0.49, 0.89]) and ISSSF (AOR 0.76, 95% CI [0.59, 0.97]), and physicians or professionals providing postnatal checkups were significantly associated with DDS (adjusted [Formula: see text]: 0.09, 95% CI [0.02, 0.16]), MDD (AOR 1.69, 95% CI [1.26, 2.26]), and ISSSF (AOR 1.30, 95% CI [1.04, 1.62]).

CONCLUSION

Knowledge of child nutritional feeding should emphasize during prenatal and postnatal obstetric care of mother, particularly during antenatal and postnatal visits, C-section delivery, and birth in a healthcare facility to eradicate malnutrition and establish healthy child feeding practices.

Gender disparity in minimum dietary diversity failure among currently breastfed children aged 6-23 months in Bangladesh: evidence from Bangladesh Multiple Indicator Cluster Survey, 2019

Research on children's dietary diversity plays a crucial role in designing effective health interventions. Thus, this study aimed to identify the factors contributing to minimum dietary diversity failure (MDDF) among male and female children aged 6-23 months in Bangladesh. The data for this study was obtained from the Bangladesh Multiple Indicator Cluster Survey, 2019, which included children currently breastfed within a specific age range. Multivariable binary logistic regression was employed to assess the strength and significance of the association. The findings revealed that approximately 59⋅4 % of children in Bangladesh experienced MDDF, with 57⋅8 % of male children and 61 % of female children affected. Proportion test uncovered a significant gender disparity (χ2=6⋅58, P-value = 0⋅01) among children aged 6-23 months. However, the multivariable binary logistic regression analysis revealed that both male and female children shared common risk factors for MDDF, which included child age, maternal educational status, wealth status, number of antenatal care visits, and division. In our study, we observed varied spatial patterns in minimal dietary diversity. Sherpur, Netrokona, Sunamganj, and Sylhet districts showed the highest failure rates. Notably, all are flood-affected areas, impacting food availability and diversity. For targeted regional development programmes, district mapping results may offer valuable insights to policymakers, especially in areas with a high prevalence of dietary diversity failure. By understanding these risk factors, policymakers and stakeholders can implement targeted strategies to improve dietary diversity among children, promoting better health and well-being for the young population in Bangladesh.

Complementary feeding practices and their determinants among children aged 6-23 months in rural Bangladesh: evidence from Bangladesh Integrated Household Survey (BIHS) 2018-2019 evaluated against WHO/UNICEF guideline -2021

BACKGROUND

Appropriate Complementary feeding (CF) practices play a crucial role in determining child nutrition, growth, and development. This study seeks to examine CF practices and their predictors among children aged 6 to 23 months in rural Bangladesh according to the most recently updated WHO/UNICEF guidelines for CF.

METHODS

A total of 665 children aged 6 to 23 months from the Bangladesh Integrated Household Survey (BIHS) 2018-2019 dataset were analyzed. The WHO/UNICEF guidelines for CF were followed to evaluate each of the nine CF practice indicators. We also examined the effect of the child, maternal, household, and community-level factors on different CF components using multiple logistic regression analyses.

RESULTS

Approximately two-thirds of the children initiated complementary feeding on time (63.5%) but had zero vegetable or fruit consumption (63.2%). More than half (52.4%) and the majority (86.5%) of children had minimum meal frequency and minimum milk feeding frequency, respectively. On the other hand, the proportion of minimum dietary diversity was quite low (18.3%), as reflected in the alarming prevalence (16.3%) of minimum acceptable diet. Egg and/or flesh food, sweet beverage, and unhealthy food consumption were 23.3%, 2.5%, and 12.2%, respectively. Child age, mothers' education level, antenatal care visit, household food security, monthly household income, and place of residence were found to be associated with CF practices.

CONCLUSION

When compared to results obtained using the previous guideline, the new one has resulted in a lower prevalence of Introduction of solid, semi-solid, or soft foods (ISSF), Minimum dietary diversity (MDD), Minimum meal frequency (MMF), and Minimum acceptable diet (MAD). It is crucial to convey the new knowledge for better child feeding and nutrition as the country prepares to apply the new guideline.

Minimum Dietary Diversity Among Children Aged 6-59 Months in East Africa Countries: A Multilevel Analysis

Objective: To find out the determinants of minimum dietary diversity (MDD) among under-five children in East Africa based on the 2017 revised indicator. Methods: Secondary data from the demographic and health survey (DHS) of eight countries in East Africa were combined. A total of 27,223 weighted samples of children aged 6-59 months were included. Multi-level logistic regression analysis was employed to identify the determinants of dietary diversity. Results: The magnitude of adequate MDD in East Africa was found to be 10.47% with 95% CI (10.12-10.84) with the lowest and highest magnitude in Ethiopia and Rwanda respectively. Having a mother in the age group of 35-49, having a mother with higher educational attainment, and having a post-natal check-up within 2 months were significant factors in determining adequate MDD. Conclusion: The magnitude of adequate MDD intake among children aged 6-59 months in East Africa is relatively low. Therefore, strengthening interventions focused on improving the economic status of households, the educational status of mothers, and diversified food consumption of children aged 6-59 months should get priority to improve the recommended feeding practice of children.

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.

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

Background

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

Methods

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

Results

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

Conclusion and Recommendations

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

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.

Type of terrain and infant and young child feeding practices: cross-sectional study findings on children below 2 years of age from northern Bangladesh

INTRODUCTION

Optimal feeding practices are vital for the subsistence, adequate nutrition, physical growth and mental development of infants and young children. This study aimed to examine the prevalence of core infant and young child feeding (IYCF) indicators and their associations with the type of terrain, that is, geographical area or zone among the beneficiaries of a large-scale nutrition programme, Suchana, being carried out in the northern part of rural Bangladesh.

METHODOLOGY

A cross-sectional study was conducted from November 2016 to February 2017 in Sylhet and Moulvibazar districts of Sylhet Division, Bangladesh. Data pertaining to 5440 children aged below 24 months were analysed for this study. Univariate analysis was carried out to establish the prevalence of the indicators; selected variables were subjected to multiple regression model to identify independent relationships between the IYCF indicators and the type of terrain stratified as plain land, hilly area, flash-flood prone area and haor (wetland).

RESULTS

In logistic regression analysis, flash-flood prone areas were significantly associated with higher exclusive breast feeding (1.92, 95% CI 1.12 to 3.30; p=0.019), minimum meal frequency (1.45, 95% CI 1.07 to 1.97; p=0.018) and minimum dietary diversity (1.63, 95% CI 1.01 to 2.63; p=0.046) compared with plain land. Moreover, hilly areas were associated with significantly lower introduction of solid, semisolid or soft foods (0.39, 95% CI 0.18 to 0.82; p=0.013) compared with plain land.

CONCLUSION

The observed prevalence of the indicators can be set as benchmark while prioritising interventions aimed at improving IYCF practices among underprivileged families residing in different types of rural setting in Bangladesh.

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.

Trends and determinants of minimum dietary diversity among children aged 6-23 months: a pooled analysis of Indonesia Demographic and Health Surveys from 2007 to 2017

OBJECTIVE

To examine minimum dietary diversity (MDD) trends and determinants among children aged 6-23 months.

DESIGN

Secondary analysis of the Indonesia Demographic and Health Surveys (IDHS) between 2007 and 2017. The primary outcome was MDD, the consumption of at least five out of eight food groups (MDD-8). We included a total of 5015 (IDHS 2007), 5050 (IDHS 2007) and 4925 (IDHS 2017) children aged 6 to 23 months to estimate trends of MDD-8 and to identify factors associated with MDD-8. We used multiple logistic regression analysis adjusted for the complex sampling design to investigate the association between the study factors and MDD-8.

SETTING

Indonesia.

PARTICIPANT

A total of 14 990 children aged 6-23 months.

RESULTS

Over the 10 years, the percentage of children who consumed a diversified diet was 53·1 % in 2007, 51·7 % in 2012 and 53·7 % in 2017. Multivariate analyses showed that older age children, higher maternal education, maternal weekly access to media, paternal non-agricultural occupation, history of at least four antenatal care visits and wealthier households were associated with the increased odds of MDD-8. Children living in rural areas, Sulawesi and Eastern Indonesia, were less likely to eat a diversified diet.

CONCLUSIONS

The proportion of children meeting MDD-8 has stagnated in the last decade. Child, parental, health care, household and community factors are associated with MDD-8. Therefore, nutrition education programmes and behaviour change communication activities should target mothers and families from socio-economically and geographically disadvantaged populations.

Women empowerment and minimum daily meal frequency among infants and young children in Ghana: analysis of Ghana demographic and health survey

Background

The nutritional quality of food has an important impact on the health and well-being of families, especially children whose bodies need to grow, develop and reach their full physical and mental potential. Traditionally, women in Ghana provide care and nourishment for their children and families if they have the means to do so or if they are financially, legally and socially empowered. Women’s empowerment is not only important for women’s human rights, but also improves nutrition and health outcomes of both mothers and their children. Women’s empowerment is concerned with increasing ability to make strategic life choices in situations where the ability was hitherto denied. This study sought to investigate the association between women’s empowerment and minimum daily meal frequency (minimum number of meals to be consumed in a day) in Ghana.

Methods

The study used data from the 2014 Ghana Demographic and Health Survey (GDHS). A sample of 1640 mother-child dyad was used. Mothers ages ranged from 15 to 49 while children’s ages ranged from 6 to 23 months. Univariate and multiple linear regression techniques were applied to identify women empowerment (economic, socio-familial and legal) and sociodemographic factors associated with minimum daily meal frequency scores. Data was analyzed by the STATA statistical package software version 13.0. Statistical significance level was set at P < 0.10.

Results

Data from decisions on large household purchases (β = 0.351, p < 0.01) family visits (β = 0.743, p < 0.01), home ownership (β = − 0.245, p < 0.10), age of child (β = 1.387, p < 0.01), mother’s educational attainment (β = 0.496, p < 0.10) and place of residence (β = − 0.298, p < 0.10) showed significant positive association with minimum daily meal frequency in Ghana.

Conclusion

Minimum daily meal frequency was largely influenced by economic and socio-familial factors that contribute to empowerment of women. as decisions on large household purchases and family visits showed significant positive association with minimum daily meal frequency. Interventional programs should target households and mothers with lower socio-demographic characteristics such as lower educational levels and low economic status to improve minimal daily meal frequency in their children thereby ensuring better child health and well-being.

Minimum daily meal frequency is influenced by various dimensions of empowerment of women such as economic and socio-familial empowerment.

There is the need for improved advocacy for women to be involved in decision-making on family visits and large household purchases as these activities promote frequent meal attainment of children

Interventional programs should target households and mothers with lower socio-demographics characteristics such as lower educational level, lower income and those residing in rural areas to improve feeding at least the minimum daily meal frequency to children for their better health and well-being.

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

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

Prevalence of Minimum Meal Frequency Practice and Its Associated Factors among Children Aged 6 to 23 Months in Ethiopia: A Systematic Review and Meta-analysis

Background. Inappropriate complementary feeding practices are amongst the key causes of child undernutrition. It rises the risk of undernutrition, illness, and mortality among children. Objectives. This study was aimed to determine the pooled prevalence of MMF practice and associated factors among children aged 6 to 23 months in Ethiopia. Methods. The search was conducted by using the following electronic databases; PubMed/MEDLINE, HINARI, EMBASE, Google Scholar, Web of Science, Scopus, African journals, and Google for grey literature. The publication bias was determined by using a funnel plot and Egger's test. The heterogeneity between the studies was checked by using I ² statistic. The subgroup analysis was done by sample size, region, and year of publication. Result. A total of 20 studies with 12 656 study participants were included in the present systematic review and meta-analysis. The pooled prevalence of MMF practice among children aged 6 to 23 months in Ethiopia was estimated to be 63.80% (95%CI: 56.59, 71.01). PNC visit (AOR = 1.90, 95%CI [1.31, 2.49]), wealth index (AOR = 2.11, 95%CI [1.42, 2.81]) and age of child (AOR = 5.75, 95%CI [4.25, 7.26]) were factors significantly associated with MMF among children aged 6 to 23 months. Conclusion. The findings showed that the pooled prevalence of MMF among children aged 6 to 23 months in Ethiopia was relatively low. PNC visit, wealth index and age of child were factors significantly associated with MMF among children aged 6 to 23 months. Therefore, community-based health education concerning the recommended MMF among children aged 6 to 23 months is required to take place.

Minimum Dietary Diversity Practice and Associated Factors among Children Aged 6 to 23 Months in Dire Dawa City, Eastern Ethiopia: A Community-Based Cross-Sectional Study

Objective: Malnutrition because of poor dietary diversity contributing to child morbidity and mortality. Two-thirds of child mortality occurs within the first 2 years. However, there is limited data related to dietary diversity among children aged 6 to 23 months in Ethiopia. Thus, this study aimed to assess dietary diversity and factors among children aged 6 to 23 months in the study setting. Methods: A community-based cross-sectional study conducted on 438 children aged 6 to 23 months in Dire Dawa, 1-30/02/2019. Simple random sampling was used to select study subjects. Data collected using a structured and pretested interview administered questionnaire. Data entered using EpiData 4.2 and analyzed with SPSS Version 22. Multivariable logistic regression was used to examine associated factors. Adjusted odd-ratio with 95% confidence interval (CI) used, and P-value <.05 considered statistically significant. Results: The overall minimum dietary diversity practice was 24.4% (95% CI: 20.3, 28.5). Maternal education [AOR 2.20; 95% CI: 1.08, 4.52], decision-making [AOR = 2.5; 95% CI: 1.19, 5.29], antenatal care [AOR = 2.19; 95% CI: 1.20, 3.99], postnatal care [AOR = 6.4; 95% CI: 2.78, 14.94] and facility delivery [AOR = 2.66; 95% CI: 1.35, 5.25] were maternal factors. Moreover, child’s age [AOR = 2.84; 95% CI: 1.39, 5.83], and child’s sex [AOR = 2.85; 95% CI: 1.64, 4.94] were infant factors. Conclusion: One-fourth of children practiced minimum dietary diversity. Child’s age, birth interval, postnatal care, antenatal care, child’s sex, mothers’ decision-making, mothers’ education, and place of delivery were significant predictors. Therefore, maternal education, empowering women, and improve maternal service utilization are crucial to improving dietary diversity.

Optimal Household Water Access Fosters the Attainment of Minimum Dietary Diversity among Children Aged 6-23 Months in Malawi

Along with sanitation and hygiene, water is a well-known driver of child undernutrition. However, a more direct role of household (HH) water access in shaping dietary diversity remains unexplored. We assessed the association between HH water access and achievement of minimum dietary diversity (MDD) among young children. We utilized nationally-representative cross-sectional data from the 2015/16 Malawi Demographic and Health Survey, which included 4727 mother–child dyads, respectively, (26.8 ± 6.8 years, range 15–49 years) and (13.9 ± 4.9 months, range 6–23 months). HH water access was categorized as (1) basic or no access, (2) intermediate, or (3) optimal. MDD was defined as feeding a child, during the previous day, at least four of the food groups defined by the World Health Organization. Only 27.7% of the children achieved MDD standards; most of the children who achieved MDD were from HHs with optimal water access (58.4%, p < 0.001). However, only 5.9% of the mother–child dyads were from HHs with optimal water access. After adjusting for covariates, children from HHs with optimal water access had higher odds of achieving MDD than those from HHs with basic or no water access (aOR = 1.74, CI = 1.24–2.46). Our results highlight the need to incorporate water-based strategies into national nutritional policies to increase dietary diversity among Malawian infants and young children.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

Magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6-23 months in Western Ethiopia

Background

Appropriate complementary feeding has the potential to prevent 6 percent of all under five deaths particularly in developing countries. However, infant and young child feeding practices in Ethiopia are suboptimal. Data on complementary feeding practices in Horro district are also lacking. Therefore, this study aimed to determine magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6–23 months in Horro district, Western Ethiopia.

Methods

Community based cross sectional study was conducted from February to March 2016 in six kebeles of Horro district, Western Ethiopia. A total of 325 mothers of children age 6–23 months were included in the study. Data were collected using pre-tested interviewer administered structured questionnaire; entered into EPI-INFO version 3.5.4 and analyzed using SPSS version 20. Odds ratio was calculated with 95% CI to identify determinants of appropriate complementary feeding practice. P-values less than 0.05 were considered as statistically significant.

Results

The magnitude of appropriate complementary feeding practice in the study area was 9.91%. Lower age of child (6-11months) [AOR: 0.195, 95% CI: (0.045–0.846)], having no formal education [AOR = 0.115:95% CI: (0.002, 0.290)] and giving birth for the first time [AOR = 0.271:95% CI: (0.011, 0.463)] were factors negatively associated with appropriate complementary feeding practice.

Conclusion

Only one tenth of mothers practiced appropriate complementary feeding. This strongly calls for sustained nutrition education targeting uneducated mothers, mothers who gave birth for the first time and those with very young children to improve the practice.

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

Background

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

Methods

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

Results

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

Conclusion

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

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.

Obstetrical care is associated with child's dietary diversity in Indonesia: analysis from Demographic and Health Survey 2017

OBJECTIVE

To explore the influence of obstetrical care factors on dietary diversity and individual food group consumption in Indonesia.

DESIGN

Cross-sectional study to assess the association between pregnancy care factors and dietary diversity score, minimum dietary diversity (MDD) and consumption of seven food groups.

SETTING

Data from the Indonesia Demographic and Health Survey 2017.

PARTICIPANTS

A total of 5113 children aged 6-23 months.

RESULTS

Dietary diversity score was significantly higher for children whose mothers received four or more prenatal care visits, were delivered at a health facility, had a professionally trained delivery assistant and were delivered by C-section. Children born at a health facility and delivered by a health professional had higher odds of meeting MDD (adjusted OR (AOR) 1·45, 95 % CI 1·18, 1·79 and OR 2·10, 95 % CI 1·54, 2·87, respectively). Four or more antenatal visits, delivering at a health facility and having a professional delivery attendant were associated with higher odds of consumption of lentils (AOR 1·66, 95 % CI 1·23, 2·25, AOR 1·30, 95 % CI 1·02, 1·65 and AOR 1·79, 95 % CI 1·19, 2·69). Four or more antenatal visits, delivering at a health facility and having a professional delivery attendant had higher odds of consumption of other fruits and vegetables (AOR 1·70, 95 % CI 1·23, 2·35, OR 1·23, 95 % CI 1·03, 1·61 and OR 1·90, 95 % CI 1·29, 2·79).

CONCLUSIONS

Efforts focusing on providing nutritional education during antenatal care and delivery should be encouraged, especially for mothers seeking care outside of a health facility.

Effect of intimate partner violence of women on minimum acceptable diet of children aged 6-23 months in Ethiopia: evidence from 2016 Ethiopian demographic and health survey

Background

The absence of proper infant and young child feeding practice results in malnutrition. Intimate Partner Violence (IPV) is potentially a major factor affecting child feeding practices. However, there is limited evidence about the effect of intimate partner violence (IPV) on a minimum acceptable diet. Therefore, in this study, we hypothesized that IPV will be associated with a lack of a minimum acceptable diet among children aged 6–23 months.

Methods

We conducted a cross-sectional analysis using the Ethiopian Demographic and Health Survey (EDHS) 2016. All child-mother pairs that participated in EDHS 2016 from all regions of Ethiopia were included. The analysis included mother-child pairs where 6–23 months aged children with mothers who were ever in a committed partnership and interviewed for domestic violence were involved. The data were weighted considering enumeration areas as a cluster and place of residence as a stratum. A binary logistic regression analysis was done to identify factors independently associated with a minimum acceptable diet.

Result

Totally, 1307 observations were included in the final analysis. The mean age of mothers was 29 years (standard deviation ±6.54 years), the mean age of children was 14. ± 5.02 months, and 32% of women had intimate partner violence (IPV). Of the children, 8% had a minimum acceptable diet (minimum acceptable diet), 15% had a minimum dietary diversity, and 43% had a minimum meal frequency. Having intimate partner violence decreases children minimum acceptable diet by 65% (AOR: 0.35; 95% CI: 0.16, 0.77). The other factors associated with the minimum acceptable diet were caregivers attaining a secondary level of education (AOR: 4.01; 95% CI: 1.04, 15.45), currently working (AOR: 2.26; 95% CI: 1.01, 5.11), and undecided fertility desire (AOR: 4.72; 95% CI: 1.37, 16.28).

Conclusion

Intimate partner violence against women had a negative association with the minimum acceptable diet children have received. Decreasing violence against women, educating, and increasing work opportunities for them would help in improving child feeding practice and reducing malnutrition and its consequences. Further studies that focus on possible community-based interventions aiming to decrease IPV are recommended.

Associations of maternal resources with care behaviours differ by resource and behaviour

Care is important for children's growth and development, but lack or inadequacy of resources for care can constrain appropriate caregiving. The objectives of this study were to examine whether maternal resources for care are associated with care behaviours specifically infant and young child feeding, hygiene, health-seeking, and family care behaviours. The study also examined if some resources for care are more important than others. This study used baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia. Measures of resources for care were maternal education, knowledge, height, nourishment, mental well-being, decision-making autonomy, employment, support in chores, and perceived instrumental support. Multiple regression analyses were conducted to examine the associations of resources for care with child-feeding practices (exclusive breastfeeding, minimum meal frequency, dietary and diversity), hygiene practices (improved drinking water source, improved sanitation, and cleanliness), health-seeking (full immunization), and family care (psychosocial stimulation and availability of adequate caregiver). The models were adjusted for covariates at child, parents, and household levels and accounted for geographic clustering. All measures of resources for care had positive associations with care behaviours; in a few instances, however, the associations between the resources for care and care behaviours were in the negative direction. Improving education, knowledge, nutritional status, mental well-being, autonomy, and social support among mothers would facilitate provision of optimal care for children.

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

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

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study

BACKGROUND

This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border.

METHODS

This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads.

RESULTS

Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant's stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices.

CONCLUSIONS

Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.

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

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

Magnitude and determinants of complementary feeding practices in Ethiopia: A systematic review and meta-analysis

BACKGROUND & AIM

Concurrent estimates on the magnitude and evidence on the determinants of complementary feeding (CF) practices in Ethiopia are currently disparate. Hence, this systematic review and meta-analysis assessed the magnitude and determinants of CF among children age 6-23 months in Ethiopia.

METHODS

Studies from various databases published until July 2018 were identified, selected, extracted and assessed for risk of bias by two authors independently. A random-effects model was used to pool the prevalence and odds ratios (ORs).

RESULTS

26 studies with 17, 383 children were included. The pooled prevalence estimate of timely initiated CF, minimum dietary diversity (DD), minimum meal frequency and minimum acceptable diet were 61.0%, 18.0%, 56.0%, and 10.0% respectively. The pooled prevalence of timely initiation and minimum DD were higher in Northern Ethiopia. On the other hand, except for the minimum meal frequency, all the three core indicators of CF were better in urban than rural settings. Child age, maternal and/or paternal education, paternal involvement, maternal DD, antenatal and postnatal care, and place of delivery were the main determinants that can increase appropriate CF practices.

CONCLUSION

The reported estimates of the prevalence of core CF indicators in Ethiopia remained poor. Therefore, the authors would like to acknowledge the effort that has been done by the minister of health and its partners including Alive & Thrive to improving CF practices in the country, however, these programs should be done more thoroughly, and scaled up by applying and adapting tested, proven approaches and tools in contexts.

Factors associated with complementary feeding practices among children aged 6-23 mo in Malawi: an analysis of the Demographic and Health Survey 2015-2016

Background

Optimal child complementary feeding practices are crucial for nutritional status, growth, development and health, and ultimately affect child survival. This is the first population-based study in Malawi that aimed to examine factors associated with complementary feeding practices among children aged 6-23 mo.

Methods

Utilizing data from the 2015-16 Malawi Demographic and Health Survey (MDHS), 4732 children aged 6-23 mo and their mothers were analysed. The MDHS produced a nationally representative sample using a multistage cluster sampling design that included sampling weights. The impact of child, maternal, household, community and health service utilization factors on complementary feeding practices was examined using the generalized estimating equation logistic regression.

Results

After controlling for a wide range of covariates, children from mothers with secondary or post-secondary education and from mothers working in agriculture and living in the central region were significantly more likely to have timely introduction to solid, semi-solid or soft food. Surprisingly, being >1 y of age was associated with reduced odds of achieving minimum meal frequency. In addition, children >1 y of age from mothers older than 24 y and from mothers with primary, secondary and post-secondary education were significantly more likely to achieve minimum dietary diversity. Children from rich households were more likely to achieve both minimum dietary diversity and minimum acceptable diet. Finally, exposure to mass media was significantly associated with increased odds of achieving minimum meal frequency, minimum dietary diversity and minimum acceptable diet.

Conclusions

Public health strategies aimed at reducing childhood undernutrition should focus on children from poor households whose mothers have no formal education and are unemployed. In addition, exposure to mass media had a positive impact on the three complementary feeding indicators. Therefore behaviour change communication messages through mass media aimed at promoting child nutrition are necessary to achieve optimal child complementary feeding practices.

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.

Uptake of minimum acceptable diet among children aged 6-23 months in orthodox religion followers during fasting season in rural area, DEMBECHA, north West Ethiopia

Background

Under-nutrition is the cause for poor physical and mental development and has more burden among infants and young children aged between 6 and 23 months. Cultural practices like not providing animal source foods for infants and young child aged between 6 and 23 months were barrier for practicing proper children feeding. The aim of this study was to assess minimum acceptable diet and associated factors among children aged between 6 and 23 months in Orthodox religion during fasting season in rural area, Dembecha, Ethiopia.

Methods

A community-based cross-sectional study was conducted to assess Minimum Acceptable diet.

Random sampling technique was applied to select 506 study participants. Interview was used to collect data on Practice of minimum acceptable diet, minimum dietary diversity, minimum meal frequency and related factors among children aged between 6 and 23 months from mothers / caregivers.

Result

About 8.6% of infants and young children aged between 6 and 23 months received minimum acceptable diet. Education status of mother(AOR = 0.22,95%CI:0.1, 0.48), involvement of mother in decision making (AOR = 0.22,95%CI:0.10,0.48), birth order of index children (AOR = 0.36,95%CI:0.14,0. 94), knowledge on feeding frequency (AOR = 0.3,95% CI:0.16,0.58), and institutional delivery (AOR = 5.13, 95%CI: 1.26, 20.80) were significantly associated with minimum acceptable diet.

Conclusion

Minimum acceptable diet practice was low. Educational status of mother, involvement of mother in decision making, knowledge on feeding frequency and institutional delivery were significantly associated with minimum acceptable diet. This indicates that nutrition education and counseling related to infant and young child feeding practice is not addressed for all mothers. Strengthening mothers’ education on acceptable child feed practice, and working with religion leaders to increase knowledge of mothers on child feed practice are recommended.

Electronic supplementary material

The online version of this article (10.1186/s40795-019-0274-y) contains supplementary material, which is available to authorized users.

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.

Feeding Practices and Undernutrition in 6⁻23-Month-Old Children of Orthodox Christian Mothers in Rural Tigray, Ethiopia: Longitudinal Study

Fasting period and fasting status affect the feeding practices and nutritional status of Ethiopian Orthodox mothers. Even if children are exempted from fasting, some mothers do not prepare their food from animal sources as it could contaminate utensils for cooking family foods. Therefore, the objective of this study was to assess feeding practices and undernutrition in 6⁻23-months old children whose mothers are Ethiopian Orthodox religion followers during lent fasting and non-fasting periods in rural Tigray, Northern Ethiopia, and to identify associated factors. A community-based longitudinal study was carried out in Ethiopian Orthodox lent fasting and non-fasting periods. Using a multi-stage systematic random sampling technique, 567 and 522 children aged 6⁻23 months old participated in the fasting and non-fasting assessments, respectively. Statistical analyses were done using logistic regression, an independent sample t-test, Wilcoxon signed-rank (WSRT) and McNemar's tests. The prevalences of stunting, underweight and wasting were 31.6⁻33.7%, 11.7⁻15.7% and 4.4⁻4.8%, respectively. The weight-for-height (WHZ) and height-for-age (HAZ) values for children of fasting mothers were significantly lower (p < 0.05) compared to those of non-fasting mothers. Likewise, the median weight-for-age (WAZ) and diet diversity score (DDS) of children of fasting mothers were also significantly higher in non-fasting than in fasting periods. A small proportion of children (2.3⁻6.7%) met the minimum acceptable diet (MAD) in the study population, but these measures were significantly increased (p < 0.001) in the children of non-fasting mothers. Mother's fasting during lactation period of the indexed child was amongst the independent factors common in child stunting, underweight and wasting. Nutritional status and feeding practices of 6⁻23-month-old children are affected by maternal fasting during the fasting period. Therefore, without involvement of religious institutions in the existing nutritional activities, reduction of undernutrition would not be successful and sustainable.

Trends and determinants of complementary feeding practices in Tanzania, 2004-2016

Background

Following the successful implementation of the Millennium Development Goals (MDGs) strategy in Tanzania, improvements in child health indicators were observed. However, it remains unclear whether complementary feeding practices have improved given the renewed global agenda on child nutrition. This study investigated trends and socioeconomic and health service factors of complementary feeding practices in Tanzania for the period spanning from 2004 to2016.

Methods

The study was based on the Tanzania Demographic and Health Survey data for the years 2004-2005 (n = 2480), 2010 (n = 2275) and 2015-2016 (n = 2949) to estimate the trends in complementary feeding practices. Multivariate logistic regression models that adjusted for year of the survey, clustering and sampling weights were used to investigate the association between the modifiable study factors (socioeconomic and health service factors) and complementary feeding practices among children aged 6-23 months in Tanzania.

Results

Over the study period, minimum dietary diversity (MDD) and minimum acceptable diet (MAD) have worsened from 46% (95% confidence interval [95% CI] 41.5-50.7%) in 2004-2005 to 30% (95% CI 25.7-32.9%) in 2015-2016 and 16.9% (95% CI 14.9-18.9%) in 2004-2005 to 6.0% (95% CI 4.9-7.1%) in 2015-2016, respectively. Minimum meal frequency (MMF) remained unchanged, 37% in 2004-2005 and 2015-2016. The introduction of solid, semi-solid and soft foods improved from 79% (95% CI 74.5-83.9%) in 2004-2005 to 87% (95% CI 83.7-90.9%) in 2015-2016. Multivariate analyses revealed that higher maternal education and household wealth, mother's employment, health facility birthing and postnatal care (PNC) visit were associated with MDD, MAD and MMF. Traditional birth attendant-assisted births and PNC visits were associated with the introduction of complementary foods. In contrast, birthing in the health facility was associated with the delayed introduction of complementary foods.

Conclusion

Between 2004 and 2016, the prevalence and determinants of complementary feeding practices varied in Tanzania. Improving complementary feeding practices is feasible in Tanzania given the renewed focus on child nutrition in the country. Child nutrition policy interventions should target all mothers, particularly mothers from low socioeconomic background and those with limited access to health services to maximise results.

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

OBJECTIVE

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

DESIGN

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

SETTING

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

SUBJECTS

Total of 8364 children aged 6-23 months.

RESULTS

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

CONCLUSIONS

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

Prevalence of exclusive breastfeeding practice and associated factors among mothers having infants less than 6 months old, in Bahir Dar, Northwest, Ethiopia: a community based cross sectional study, 2017

Background

Breast milk provides all the energy and nutrients that the infant needs for the first 6 months of life. Suboptimal breastfeeding especially lacks exclusive breastfeeding increase risk of severe acute malnutrition by 3.2-fold and major contributory factor for infant child mortality. Therefore, the objective of this study was to assess the prevalence of exclusive breastfeeding practice and associated factors among mothers having infants less than 6 months old in Bahir Dar city, Northwest, Ethiopia, 2017.

Result

The prevalence of exclusive breastfeeding practice 1 day before the survey was 86.4%. Mothers who; have young infant aged 0–1 month old [AOR = 5.702 (1.747, 18.613)], house wife [AOR = 2.995 (1.557, 5.690)] and are not influenced by culture [AOR = 11 (3.449, 35.165)] were more likely to practice exclusive breastfeeding than their counterparts.

Mother's Infant and Young Child Feeding (IYCF) knowledge improved timely initiation of complementary feeding of children aged 6-24 months in the rural population of northwest Ethiopia

Objectives

Appropriate complementary feeding is vital to reduce young child morbidity and mortality. However, it continues as sub-optimal in Ethiopia, and literatures are also scarce. Therefore, this study aimed to determine timely initiation of complementary feeding and associated factors among mothers with children aged 6–24 months in the rural population of northwest Ethiopia. In the community based cross-sectional study, data on child feeding practices, individual and household characteristics were collected in Dabat Demographic Surveillance System site, Dabat District, northwest Ethiopia from 01 May to 29 June 2015. The bivariate and backward stepwise multivariable statistical methods were carried out to identify factors associated with timely initiation of complementary feeding.

Results

About 53.8% [95% CI 45.9, 61.7] and 4.6% [95% CI 1.3, 7.9] of children were found with timely initiation of complementary feeding and had minimum dietary diversity, respectively. The odds of timely initiation of complementary feeding was higher among mothers with medium [AOR = 2.34, 95% CI 1.54, 3.81] and high [AOR = 2.10, 95% CI 1.41, 3.87] mother’s IYCF knowledge. In Dabat district, complementary feeding practice is lower. Thus, efforts should be strengthened to boost mother’s IYCF knowledge.

Complementary feeding practices: Current global and regional estimates

Insufficient quantities and inadequate quality of complementary foods, together with poor feeding practices, pose a threat to children's health and nutrition. Interventions to improve complementary feeding are critical to reduce all forms of malnutrition, and access to data to ascertain the status of complementary feeding practices is essential for efforts to improve feeding behaviours. However, sufficient data to generate estimates for the core indicators covering the complementary feeding period only became available recently. The current situation of complementary feeding at the global and regional level is reported here using data contained within the UNICEF global database. Global rates of continued breastfeeding drop from 74.0% at 1 year of age to 46.3% at 2 years of age. Nearly a third of infants 4-5 months old are already fed solid foods, whereas nearly 20% of 10-11 months old had not consumed solid foods during the day prior to their survey. Of particular concern is the low rate (28.2%) of children 6-23 months receiving at least a minimally diverse diet. Although rates for all indicators vary by background characteristics, feeding behaviours are suboptimal even in richest households, suggesting that cultural factors and poor knowledge regarding an adequate diet for young children are important to address. In summary, far too few children are benefitting from minimum complementary feeding practices. Efforts are needed not only to improve children's diets for their survival, growth, and development but also for governments to report on progress against global infant and young child feeding indicators on a regular basis.

Dietary diversity and anthropometric status and failure among infants and young children in Sri Lanka

OBJECTIVES

We investigate the association between child dietary diversity and anthropometric status and failure in Sri Lanka while accounting for other child and household factors by employing multivariable logistic and linear regression analyses.

METHODS

Using a nationally representative survey of children ages 6 mo to 59 mo, child dietary diversity was based on the 24-h recall of a child's food intake across seven food groups. The minimum dietary diversity was a score of four or above. Anthropometric status (i.e., height for age (HAZ), weight for age, and weight for height z-scores) and failure (i.e., stunting, wasting, and underweight) were calculated.

RESULTS

The prevalence of stunting, wasting, and underweight was 15%, 21%, and 26%, respectively. The prevalence of inadequate dietary diversity was 9%. Child dietary diversity was positively associated with HAZ (b = 0.02; standard error = 0.01; P = 0.04) but not with any indicator of anthropometric failure. However, low birth weight, wealth, and location were strong risk factors for anthropometric status and failure. Analyses stratified by child age indicated that dietary diversity was positively associated with anthropometric status for children ages 24 mo to 59 mo (HAZ: b = 0.03; standard error = 0.01; P = 0.02). Mixed associations were found for children ages 6 mo to 12 mo and there were no associations for children ages 12 mo to 24 mo.

CONCLUSIONS

Child dietary diversity predicted anthropometric status among children ages ≥24 mo. Interventions to address both proximal and distal risk factors for anthropometric status may be necessary in Sri Lanka to reduce anthropometric failure among infants and young children.

Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs

BACKGROUND

Understanding the context of infant and young child feeding (IYCF) is recognized as essential for designing appropriate complementary feeding interventions.

OBJECTIVE

Our objective was to study household IYCF behaviors in 2 districts in southern and northern Ghana to identify opportunities to improve existing nutrition programs.

METHODS

We interviewed 80 caregivers of children aged 6 to 23 months using ethnographic methods, including free listing, guided discussions and cognitive mapping techniques, and 24-hour dietary recall. Descriptive statistics and thematic content analysis were used to analyze quantitative and qualitative data.

RESULTS

In both settings, children's diets were predominantly maize based. Fish, the main animal source food, was consumed daily but in very small quantities. Milk was consumed by only a few children, in tea and porridge. Fruits were seldom consumed. Household food production did not meet requirements, and the markets were heavily relied on for staples and other key ingredients. Most caregivers demonstrated basic knowledge and understanding of key health and nutrition concepts. Barriers to optimal child feeding identified were lack of money to purchase the nutritious foods recommended for children, seasonal food insecurity, and some caregiver beliefs, practices, and nutrition knowledge gaps. Positive contextual features include caregiver recognition of the dietary needs of young children and commitment to provide foods to meet these needs.

CONCLUSION

Our findings suggest that complementary feeding in these rural settings can be improved through reinforcement or modification of strategic components of local health and nutrition education in light of existing barriers and enablers to optimal IYCF.