Effect of early complementary feeding on nutritional status in term infants in rural Nigeria

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

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

DATA EXTRACTION

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

DATA ANALYSIS

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

CONCLUSION

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020218517.

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

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

Facilitators and Barriers to Breastfeeding and Exclusive Breastfeeding in Kilimanjaro Region, Tanzania: A Qualitative Study

Background

Breastfeeding is the best way to feed infants. It is a simple intervention to improve child health and development. Despite its advantages, there is a low global rate of exclusive breastfeeding (EBF) and, in Kilimanjaro region, Tanzania, EBF is rarely practiced. The aim of this paper is to explore social and cultural factors that might influence the practice of breastfeeding and exclusive breastfeeding in Kilimanjaro region.

Methods

A qualitative design was used. Three districts in Kilimanjaro region, namely, Same, Moshi Municipal Council, and Rombo, were selected. In each district three focus group discussions (FGDs) were conducted with mothers with infants aged 0-12 months.

Results

A total of 78 mothers participated in the focus group discussions. A majority of the mothers were positive towards breastfeeding. They believed that it prevents child sickness, creates happiness, and is good for family economy. Despite the positive attitudes, the mothers revealed many perceptions that interfered with breastfeeding and exclusive breastfeeding. These included the following: breast milk is very light and has bad odor, breastfeeding may affect mothers appearance, chango (abdominal pain) has to be treated, there is fear of the evil eye when breastfeeding in public places, breast milk may become unclean, and there is a need of pauses in breastfeeding after the child has burped on the breast.

Conclusion

There are beliefs that promote the practice of breastfeeding in this setting; these local beliefs could be used to develop breastfeeding messages to improve breastfeeding practices. However, there is also a need to address beliefs that interfere with the practice of exclusive breastfeeding in this setting.

Systematic review of infant and young child complementary feeding practices in South Asian families: the India perspective

OBJECTIVE

Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in India.

DESIGN

Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' and derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).

RESULTS

From 45 712 abstracts screened, sixty-four cross-sectional, seven cohort, one qualitative and one case-control studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF practices were found in all studies. In twenty-nine of fifty-nine studies, CF was introduced between 6 and 9 months, with eight studies finding minimum dietary diversity was achieved in 6-33 %, and ten of seventeen studies noting minimum meal frequency in only 25-50 % of the study populations. Influencing factors included cultural influences, poor knowledge on appropriate CF practices and parental educational status.

CONCLUSIONS

This is the first systematic review to evaluate CF practices in SA in India. Campaigns to change health and nutrition behaviour and revision of nationwide child health nutrition programmes are needed to meet the substantial unmet needs of these children.

Trends in complementary feeding indicators in Nigeria, 2003-2013

OBJECTIVE

The study aimed to examine secular trends and determinants of changes in complementary feeding indicators in Nigeria.

DESIGN, SETTING AND PARTICIPANTS

Data on 79 953 children aged 6-23 months were obtained from the Nigeria Demographic and Health Surveys (NDHS) for the period spanning 2003-2013. The surveys used a stratified two-stage cluster sample of eligible mothers aged 15-49 years from the six geopolitical zones of Nigeria. Trends in complementary feeding indicators and socioeconomic, health service and individual characteristics including factors associated with complementary feeding indicators were examined using multilevel logistic regression analyses.

RESULTS

Minimum dietary diversity for children aged 6-23 months worsened from 26% in 2003 to 16% in 2013. Minimum meal frequency improved from 43% in 2003 to 56% in 2013 and minimum acceptable diet worsened from 11% to 9%. Among educated mothers, there was a decreasing prevalence of the introduction of solid, semisolid and soft foods in infants aged 6-8 months (67% in 2003 to 57% in 2013); minimum dietary diversity (33% in 2003 to 24% in 2013) and minimum acceptable diet (13% in 2003 to 8% in 2013). Mothers with a higher education level and mothers who reported more health service contacts were more likely to meet the minimum dietary diversity. Similarly, the odds for minimum acceptable diet were higher among mothers from higher socioeconomic status groups and mothers who reported frequent health services use.

CONCLUSIONS

Complementary feeding practices in Nigeria declined over the study period and are below the expected levels required to ensure adequate growth and development of Nigerian children. National policies and programmes that ensure sustainability of projects post-MDGs and higher health service coverage for mothers, including community-based education initiatives, are proposed to improve complementary feeding practices among Nigerian mothers.

Determinants of inappropriate timing of introducing solid, semi-solid or soft food to infants in Pakistan: secondary data analysis of Demographic and Health Survey 2006-2007

Inappropriate timing of introducing complementary food deprives the infant of optimum nutrition, leading to undernutrition, and increased mortality and morbidity. The aim of this analysis was to identify determinants of inappropriate timing of introduction of solid, semi-solid and soft foods in Pakistan. Data on 941 infants 3.00 to 8.99 months were obtained from the Pakistan Demographic and Health Survey 2006-2007. The prevalence of introduction of foods among infants aged 3.00-5.99 months and 6.00-8.99 months was examined against a set of individual, household and community level variables using univariate analysis. Adjusted odds ratio (AOR) for early introduction in age 3.00-5.99 months and non-introduction in 6.00-8.99 months of age were calculated using backward stepwise logistic regression models. The prevalence of early introduction of complementary foods among 3.00- to 5.99-month-old and timely introduction among 6.00- to 8.99-month-old infants were 10.6% and 39.2%, respectively. Multivariate analyses revealed that mothers who had four or more antenatal clinic visits (AOR=2.68) and who lived in the provinces of Sindh (AOR=2.89) and Baluchistan (AOR=6.75) were more likely to introduce complementary foods early. Mothers from middle-level households (AOR=7.82), poorer households (AOR=4.84) and poorest households (AOR=5.72) were significantly more likely to delay introduction of complementary foods. In conclusion more than half (60.8%) of Pakistani infants do not receive complementary foods at recommended time. Public health interventions to improve the timing of introduction of complementary food are needed at national level with special focus on high risk groups.

Health benefits of selected global breastfeeding recommendations among children 0-6 months in Nigeria

The survey examined the appropriateness of selected global breastfeeding recommendations in an environment where the recommendations contradicted local knowledge and culture. Specifically, the survey assessed the implications of pre-lacteal feeding, feeding of colostrum, exclusive breastfeeding for the first 6 months of life and the use of feeding bottles for child health. Eligible mother-infant pairs were recruited for the survey by cluster sampling technique. Data was collected about the mother-infant pairs with the aid of a pre-designed questionnaire that sought information on the social and demographic characteristics of the mothers and infants, current breastfeeding practices and illnesses that the index infants had in the 2 weeks preceding the survey day. Information was canvassed from 2466 mother-infant pairs. All the infants were aged 0-6 months. Compliance with the selected recommendations were: 74.4% reported exclusive breastfeeding; 87.5% did not give pre-lacteal feeds, 78.3% were not using feeding bottles while 92.9 gave colostrum. Mothers who reported compliance with the recommendations also reported fewer episodes of the common signs of illnesses surveyed. The study confirmed the appropriateness and relevance of the selected recommendations in the study area.

Promoting the exclusive feeding of own mother's milk through the use of hindmilk and increased maternal milk volume for hospitalized, low birth weight infants (< 1800 grams) in Nigeria: a feasibility study

A feasibility study was used to determine (1) if hindmilk feedings of own mother's milk, as reported in the United States, could be instituted in a Nigerian neonatal intensive care unit and result in adequate infant weight gain without exogenous additives; and (2) if the use of a hospital-grade electric breast pump to separate foremilk from hindmilk was feasible in this setting. Mean weight gain for 16 preterm infants during the hindmilk intervention (18.8 g/d) exceeded intrauterine standards without the use of exogenous substances. At the time of hospital discharge, mean maternal daily milk volume was 342 mL/kg/d, indicating that the infants, on average, had 90% more milk available to them than they required. Mean infant weight gains were 14.2 and 16.6 g/d from 1 to 7 and 8 to 23 (x = 14.8) days postdischarge, respectively. Therefore, hindmilk feedings are effective and feasible for hospitalized, low birth weight infants in developing countries, and lactation specialists may use our protocol for further research.

Promotion of exclusive breastfeeding (EBF): the need to focus on the adolescents

This study was designed to assess the knowledge and attitude towards exclusive breast feeding among 377 female students of School of Health Technology, Ilesha and to compare their responses with 60 primigravidae attending antenatal clinic in Ile-Ife, Nigeria. The ages of the subjects ranged from 15 to 34 years. Data were collected using pretested structured questionnaire. Approximately 47% of the total population were grouped under low level of knowledge of exclusive breastfeeding. There was no significant relationship in terms of knowledge between the two groups. There was, however, a significant relationship between the age of subjects and increased level of knowledge about EBF. Seventy percent of the primigravidae were graded as having poor attitudes as compared with 18% of the female students. About 42% of the total population would give water and glucose D water to neonates within 72 hours after delivery. These findings further suggest that planners of the Baby Friendly Initiative need to focus more on adolescents and the primigravidae in the promotion of breastfeeding.

Breast feeding practices in urban and rural health centres: impact of baby friendly hospital initiative in Ile-Ife, Nigeria

The present study was carried out to assess the impact of the Baby Friendly Hospital Initiative (BFHI) on breast feeding practices. The variables used to evaluate the BFHI centre included time of initiation of breastfeeding (BF) after delivery, intended duration of BF, adoption of exclusive breastfeeding (EBF) in relation to educational status, location of health centre, and knowledge and practice of positioning the child at the breast. Observation, questionnaire and interview techniques were employed to collect the data among 217 and 214 nursing mothers (NMs) from Urban and Rural Health Centres. Of the 228 NMs who initiated BF within 30 minutes after delivery, 140 (61%) were from a designated BFHI Centre and 88 (39%) were from an undesignated BFHI rural health centre. There was a significant relationship between the practice of EBF and designation of BFHI centre (P = 0.0001). The higher the level of education of the NMs, the higher the present of NMs subscribing to EBF (P = 0.0001). The present study has also confirmed that EBF which was once considered to be less than 3%, has increased significantly to 61%. The success was not unconnected with the inauguration of BFHI. The BFHI is recording huge success in the urban area but the impact is still to be felt in the rural areas.

A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age

BACKGROUND

Koko, a fermented maize porridge used as the primary complementary food in Ghana, has been implicated in the high prevalence of child malnutrition. Weanimix, a cereal-legume blend developed by the United Nations Children's Fund and the Ghanaian government, has been promoted as an alternative.

OBJECTIVE

We evaluated the effect of feeding Weanimix and 3 other locally formulated, centrally processed complementary foods on the nutritional status of 208 breast-fed infants.

DESIGN

Infants were randomly assigned to receive 1 of 4 foods from 6 to 12 mo of age: Weanimix (W), Weanimix plus vitamins and minerals (WM), Weanimix plus fish powder (WF), and koko plus fish powder (KF). Dietary and anthropometric data were collected regularly. Blood was collected at 6 and 12 mo of age to assess iron, zinc, vitamin A, and riboflavin status. Before and after the intervention, cross-sectional data on the anthropometric status of infants not included in the intervention (NI; n = 464) were collected.

RESULTS

There were no significant differences between intervention groups in weight or length gain or in hemoglobin, hematocrit, transferrin saturation, plasma zinc, or erythrocyte riboflavin values between 6 and 12 mo of age. From 9 to 12 mo of age, z scores were lower in NI infants than in the combined intervention groups [at 12 mo: -1.71 +/- 0.90 compared with -1.19 +/- 0.93 for weight and -1.27 +/- 1.02 compared with -0.63 +/- 0.84 for length (P < 0.001 for both), respectively]. The percentage of infants with low ferritin values increased significantly between 6 and 12 mo of age in groups W, WF, and KF but not in group WM. Change in plasma retinol between 6 and 12 mo of age was significantly greater in group WM than in the other 3 groups combined (0.14 +/- 0.3 compared with -0.04 +/- 0.3 micromol/L, P = 0. 003).

CONCLUSIONS

All 4 foods improved growth relative to the NI group. Infants fed WM had better iron stores and vitamin A status than those fed nonfortified foods.

Infant feeding practices in a deprived environment: a concern for early introduction of water and glucose D water to neonates

The main objective of this study was to inquire from lactating mothers whether they were fully or partially practising exclusive breastfeeding in the first six months postnatally. Time of initiation of breast and complementary feedings, types of feeds and reasons for giving other feeds to infants apart from breast milk were also examined. The data were collected by structured pretested questionnaire. Of the 200 nursing mothers interviewed, 103 (51.5%) and 77 (38.5%) reported to have given water and glucose D water to neonates respectively within the first week of life. Sieved cornpap was the popular weaning diet. Time of introducing complementary feeding to infants, and nursing mothers' educational levels, were highly significantly related (P = 0.005). Surprisingly, none of the nursing mothers listed infant formula as one of the complementary feeds. It is concluded that there is a strong need to correct this unnecessary practice of giving water and glucose D water to neonates to prevent thirst and Jaundice respectively. The correction should commence with health workers and then the nursing mothers.