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Achiro E, Okidi L, Echodu R, Alarakol SP, Nassanga P, Ongeng D. Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda. Food Sci Nutr 2023; 11:5472-5491. [PMID: 37701219 PMCID: PMC10494620 DOI: 10.1002/fsn3.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/04/2023] [Accepted: 05/31/2023] [Indexed: 09/14/2023] Open
Abstract
The safety of homemade weaning foods in low- and middle-income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6-23 months of age in Amuru and Nwoya districts, Northern Uganda, between March 2019 and June 2019. A cross-sectional study was conducted involving 180 caregivers. Data were collected using semi-structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logistic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision-making on household income (p = .006) and households with older children (p = .041). A significant positive correlation was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.
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Affiliation(s)
- Eunice Achiro
- Department of Food Science and Postharvest Technology, Faculty of Agriculture and EnvironmentGulu UniversityGuluUganda
| | - Lawrence Okidi
- Department of Food Science and Postharvest Technology, Faculty of Agriculture and EnvironmentGulu UniversityGuluUganda
| | - Richard Echodu
- Department of Biology, Faculty of ScienceGulu UniversityGuluUganda
| | - Simon Peter Alarakol
- Department of Medical Biochemistry, Faculty of MedicineGulu UniversityGuluUganda
| | - Prossy Nassanga
- Department of Food Science and Postharvest Technology, Faculty of Agriculture and EnvironmentGulu UniversityGuluUganda
| | - Duncan Ongeng
- Department of Food Science and Postharvest Technology, Faculty of Agriculture and EnvironmentGulu UniversityGuluUganda
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Minimum acceptable diet among children aged 6-23 months in South Kivu, Democratic Republic of Congo: a community-based cross-sectional study. BMC Pediatr 2021; 21:239. [PMID: 34011304 PMCID: PMC8132412 DOI: 10.1186/s12887-021-02713-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal child nutrition remains the main factor underlying child undernutrition in Democratic Republic of Congo (DRC). This study aimed to assess the prevalence of minimum acceptable diet and associated factors among children aged 6–23 months old. Methods Community-based cross-sectional study including 742 mothers with children aged 6–23 months old was conducted in 2 Health Zones of South Kivu, Eastern DRC. WHO indicators of Infant and Young Child Feeding (IYCF) regarding complementary feeding practices were used. Logistic regression analysis was used to quantify the association between sociodemographic indicators and adequate minimum acceptable diet for both univariate and multivariate analysis. Results Overall, 33% of infants had minimum acceptable diet. After controlling for a wide range of covariates, residence urban area (AOR 2.39; 95% CI 1.43, 3.85), attendance postnatal care (AOR 1.68; 95% CI 1.12, 2.97), education status of mother (AOR 1.83; 95% CI 1.20, 2.77) and household socioeconomic status (AOR 1.72; 95% CI 1.14, 2.59) were factors positively associated with minimum acceptable diet. Conclusion Actions targeting these factors are expected to improve infant feeding practices in South Kivu. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02713-0.
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Maciel BLL, Costa PN, Filho JQ, Ribeiro SA, Rodrigues FAP, Soares AM, Júnior FS, Ambikapathi R, McQuade ETR, Kosek M, Ahmed T, Bessong P, Kang G, Shresthra S, Mduma E, Bayo E, Guerrant RL, Caulfield LE, Lima AAM. Higher Energy and Zinc Intakes from Complementary Feeding Are Associated with Decreased Risk of Undernutrition in Children from South America, Africa, and Asia. J Nutr 2021; 151:170-178. [PMID: 32939530 PMCID: PMC7779220 DOI: 10.1093/jn/nxaa271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/15/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few studies have focused on quantitatively analyzing nutrients from infant diets, compromising complementary feeding evaluation and health promotion worldwide. OBJECTIVES This study aimed to describe dietary intake in infants from 9 to 24 mo of age, determining nutrient intakes associated with the risk of underweight, wasting, and stunting. METHODS Usual nutrient intakes from complementary feeding were determined by 24-h recalls collected when infants were 9-24 mo of age in communities from 7 low- and middle-income countries: Brazil (n = 169), Peru (n = 199), South Africa (n = 221), Tanzania (n = 210), Bangladesh (n = 208), India (n = 227), and Nepal (n = 229), totaling 1463 children and 22,282 food recalls. Intakes were corrected for within- and between-person variance and energy intake. Multivariable regression models were constructed to determine nutrient intakes associated with the development of underweight, wasting, and stunting at 12, 18, and 24 mo of age. RESULTS Children with malnutrition presented significantly lower intakes of energy and zinc at 12, 18, and 24 mo of age, ranging from -16.4% to -25.9% for energy and -2.3% to -48.8% for zinc. Higher energy intakes decreased the risk of underweight at 12 [adjusted odds ratio (AOR): 0.90; 95% CI: 0.84, 0.96] and 24 mo (AOR: 0.91; 95% CI: 0.86, 0.96), and wasting at 18 (AOR: 0.91; 95% CI: 0.83, 0.99) and 24 mo (AOR: 0.83; 95% CI: 0.74, 0.92). Higher zinc intakes decreased the risk of underweight (AOR: 0.12; 95% CI: 0.03, 0.55) and wasting (AOR: 0.19; 95% CI: 0.04, 0.92) at 12 mo, and wasting (AOR: 0.05; 95% CI: 0.00, 0.76) at 24 mo. CONCLUSIONS Higher intakes of energy and zinc in complementary feeding were associated with decreased risk of undernutrition in the studied children. Data suggest these are characteristics to be improved in children's complementary feeding across countries.
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Affiliation(s)
- Bruna L L Maciel
- Nutrition Postgraduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Priscila N Costa
- Nutrition Postgraduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - José Q Filho
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Samilly A Ribeiro
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Francisco A P Rodrigues
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Alberto M Soares
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Francisco S Júnior
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Elizabeth T R McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Margaret Kosek
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tahmeed Ahmed
- Division of Nutrition and Clinical Services, icddr,b, Dhaka, Bangladesh
| | | | - Gangadeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sanjaya Shresthra
- Walter Reed/Armed Forces Research Institute of Medical Sciences (AFRIMS) Research Unit, Nepal (WARUN), Kathmandu, Nepal
| | - Estomih Mduma
- Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Eliwaza Bayo
- Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Laura E Caulfield
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aldo A M Lima
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Ariff S, Saddiq K, Khalid J, Sikanderali L, Tariq B, Shaheen F, Nawaz G, Habib A, Soofi SB. Determinants of infant and young complementary feeding practices among children 6-23 months of age in urban Pakistan: a multicenter longitudinal study. BMC Nutr 2020; 6:75. [PMID: 33323127 PMCID: PMC7739450 DOI: 10.1186/s40795-020-00401-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kamran Saddiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Javairia Khalid
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Laila Sikanderali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Batha Tariq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fariha Shaheen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Atif Habib
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Torlesse H, Aguayo VM. Aiming higher for maternal and child nutrition in South Asia. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12739. [PMID: 30499249 PMCID: PMC6588023 DOI: 10.1111/mcn.12739] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
Abstract
The sustainable development of nations relies on children developing to their full potential and leading healthy, productive, and prosperous lives. Poor nutrition in early life threatens the growth and development of children, especially so in South Asia, which has the highest burdens of stunting, wasting, and anaemia in the world. Targeted actions to reduce stunting and other forms of child malnutrition in South Asia should be informed by an understanding of what drives poor nutrition in children, who is most affected, and effective programme approaches. To this end, the UNICEF Regional Office for South Asia commissioned a series of papers in 2016–2017 to fill knowledge gaps in the current body of evidence on maternal and child nutrition in South Asia, including analyses of: (a) the links between anthropometric failure in children and child development; (b) the time trends, current distribution, disparities and inequities of child stunting, wasting and anaemia, and their direct and underlying causes, including maternal anaemia, low birth weight, breastfeeding, and complementary feeding; (c) policy and programme actions to increase the coverage of nutrition interventions during pregnancy, improve breastfeeding practices, and care for severely wasted children. This overview paper summarizes the evidence from these analyses and examines the implications for the direction of future advocacy, policy, and programme actions to improve maternal and child nutrition in South Asia.
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Affiliation(s)
- Harriet Torlesse
- Nutrition Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, UNICEF, New York, New York
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Kang Y, Aguayo VM, Campbell RK, Dzed L, Joshi V, Waid JL, Gupta SD, Haselow NJ, West KP. Nutritional status and risk factors for stunting in preschool children in Bhutan. MATERNAL AND CHILD NUTRITION 2018; 14 Suppl 4:e12653. [PMID: 30412341 PMCID: PMC6587444 DOI: 10.1111/mcn.12653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/28/2018] [Accepted: 06/21/2018] [Indexed: 01/01/2023]
Abstract
Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z‐scores of height‐for‐age [HAZ], weight‐for‐height [WHZ], and weight‐for‐age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.
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Affiliation(s)
- Yunhee Kang
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Rebecca K Campbell
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, MD
| | - Laigden Dzed
- Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | | | | | | | - Nancy J Haselow
- Asia Pacific Regional Office, Helen Keller International, Phnom Penh, Cambodia
| | - Keith P West
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, MD
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Campbell RK, Aguayo VM, Kang Y, Dzed L, Joshi V, Waid JL, Gupta SD, Haselow N, West, KP. Epidemiology of anaemia in children, adolescent girls, and women in Bhutan. MATERNAL & CHILD NUTRITION 2018; 14 Suppl 4:e12740. [PMID: 30499252 PMCID: PMC6948218 DOI: 10.1111/mcn.12740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 12/24/2022]
Abstract
Anaemia inhibits health and development in Bhutan. We estimated anaemia prevalence and explored risk factors in children and women using data from Bhutan's National Nutrition Survey 2015. Prevalence was calculated using life-stage-specific cut-offs adjusted for altitude and survey design. Risk factors were evaluated in modified Poisson regressions. Anaemia affected 42%, 29%, 36%, and 28% of children, adolescent girls, and non-pregnant and pregnant women, respectively. Risk of anaemia was greater in children who were younger (RR 2.0, 95% CI [1.7, 2.3] and RR 1.9, 95% CI [1.6, 2.3], respectively, for 12-23 and 6-11 vs. 24-59 months), male (1.2, 1.1-1.4, ref.: female), and stunted (1.2, 1.0-1.3, ref.: height-for-age ≥ -2z). Older (15-19 years) versus younger (10-14 years) adolescents were at higher risk (1.5, 1.2-1.8), as were adolescents living at home versus at school (1.2, 0.9-1.6) and those working versus studying (1.3, 1.0-1.7). Among adult women, anaemia risk increased with age (1.2, 1.0-1.4 and 1.3, 1.1-1.5, for 30-39 and 40-49, respectively, vs. 20-29 years) and was higher for women without schooling (1.1, 1.0-1.3, vs. primary schooling), who were unmarried or separated (1.4, 1.2-1.7 and 1.3, 1.1-1.6, respectively, vs. married), without a child <5 years (1.1, 1.0-1.3), and lacking improved sanitation (1.1, 1.0-1.3). High coverage of antennal iron and folic acid supplementation may contribute to the lower prevalence of anaemia among pregnant women and women with young children. Expansion of iron supplementation programmes, fortification, and other strategies to improve dietary iron intake may reduce the prevalence of anaemia, but causes of anaemia other than iron deficiency (e.g., thalassemias) should also be investigated.
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Affiliation(s)
- Rebecca K. Campbell
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | - Yunhee Kang
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Laigden Dzed
- Ministry of HealthGovernment of BhutanThimphuBhutan
| | | | | | | | - Nancy Haselow
- Regional Office for AsiaHelen Keller InternationalPhnom PehnCambodia
| | - Keith P. West,
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
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Campbell RK, Aguayo VM, Kang Y, Dzed L, Joshi V, Waid J, Gupta SD, Haselow N, West, KP. Infant and young child feeding practices and nutritional status in Bhutan. MATERNAL & CHILD NUTRITION 2018; 14 Suppl 4:e12762. [PMID: 30499253 PMCID: PMC6587771 DOI: 10.1111/mcn.12762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/09/2017] [Accepted: 11/22/2017] [Indexed: 11/27/2022]
Abstract
In South Asia, childhood undernutrition persists while overweight is increasing. Internationally recommended infant and young child feeding (IYCF) practices promote healthy nutritional status; however, little is known about IYCF in Bhutan, investigated here using 2015 National Nutrition Survey data. WHO/UNICEF IYCF indicators, anthropometry and household socio-economic status were available for 441 children <24 months. Stunting, wasting, and underweight prevalence (<-2Z length-for-age [LAZ], weight-for-age, [WAZ] and weight-for-length [WLZ], respectively) were 15%, 9%, and 5%, respectively, whereas overweight (WLZ >2) prevalence was 6%. In survey-design-adjusted analyses, 52% of mothers of 0- to 5-month olds reported exclusive breastfeeding (EBF), with EBF less common for girls than boys (OR: 0.2 [95% CI: 0.1-0.9]). Although 61% of children were breastfed at 2 years and 75% of children >6 months met a minimum daily meal frequency, only 18% of children 6-23 months met minimum dietary diversity. IYCF was unassociated with risk of stunting, wasting, or underweight, possibly due to relatively low prevalence of anthropometric failure and small sample size. However, currently-breastfed children were less often overweight [OR: ~0.1 (95% upper limit ≤1.0)]. Neither breastfeeding nor most complementary feeding practices differed by socio-economic status, but children in the highest two fifth of a wealth index had 7.8 (1.3-46.9) and 5.3 (1.1-25.2) times greater odds than children in the lowest fifth of meeting minimum dietary diversity criteria. Low rates of EBF, given possible protection of breastfeeding against overweight, and inadequate dietary diversity offer evidence to guide future program interventions to improve nutritional status of young children.
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Affiliation(s)
- Rebecca K. Campbell
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Yunhee Kang
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Laigden Dzed
- Ministry of HealthGovernment of BhutanThimphuBhutan
| | | | | | | | | | - Keith P. West,
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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