Factors associated with infants' and young children's (6-23 months) dietary diversity in Pakistan: evidence from the demographic and health survey 2012-13

Diet Quality Among Mothers and Children in India: Roles of Social and Behavior Change Communication and Nutrition-Sensitive Social Protection Programs

BACKGROUND

Limited evidence exists on determinants of maternal and child diet quality.

OBJECTIVES

This study examined the role of social and behavior change communication (SBCC) and nutrition-sensitive social protection (NSSP) programs on maternal and child diet quality.

METHODS

Data were from cross-sectional phone survey on 6627 Indian mothers that took place in late 2021. The Diet Quality Questionnaire (DQQ) was used to measure maternal and child diet quality, including minimum dietary diversity (MDD), dietary diversity scores (DDSs), noncommunicable disease (NCD)-protect and NCD-risk scores, adherence to dietary guidelines (All-5 and India-All-6), and unhealthy child feeding. Multivariate regression models were used to explore the association between diet indicators and coverage of SBCC and NSSP programs.

RESULTS

Maternal and child diet quality was suboptimal, with more mothers (57%) achieving MDD than children (23%). SBCC was positively associated with healthy food consumption in children (odds ratio [OR]: 2.14 for MDD; β: 0.60 for DDS and 0.54 for NCD-protect) and mothers (β: 0.38 for DDS and 0.43 for NCD-protect). Cash transfers were associated with healthier diets in mothers (OR: 1.45 for MDD, 1.86 for All-5, and 2.14 for India-All-6; β: 0.43 for DDS and 0.26 for NCD-protect), but less associations noted for children (β: 0.14 for NCD-protect). Receiving food was associated not only with healthier diets in mothers (OR: 1.47 for MDD; β: 0.27 for DDS and 0.33 for NCD-protect) and children (β: 0.19 for DDS and 0.15 for NCD-protect) but also with unhealthy food in children (OR: 1.34). Exposure to multiple programs showed stronger associations with diet quality.

CONCLUSIONS

SBCC has greater positive impact on child feeding than food and cash transfers, while cash has a stronger association with improved maternal diets. Food and cash are also associated with unhealthy food consumption. Our study underscores the importance of interventions that combine education, resource provision, and targeted support to promote maternal and child diet quality.

Infant and Young Child Feeding practices up to 23 months in Namuno District, Cabo Delgado, Mozambique

BACKGROUND

Inadequate breastfeeding and complementary feeding practices are key determinants of child malnutrition and impact one-third of the under-five mortality rate worldwide. The district of Namuno in Cabo Delgado (Mozambique) has been long registering a high prevalence of acute malnutrition. To date, no data exists about Infant and Young Child Feeding (IYCF) practices in the area. The current pilot study explores the feeding practices among children aged 0-23 months in Namuno and sets out its main drivers.

METHODS

This cross-sectional study was realized between August and September 2019 and drew on questionnaires for mothers/caregivers of children aged 0 to 23 months. We computed IYCF indicators and correlated them with mothers'/caregivers' school attendance, delivery setting, and distance between home and the place where livelihood activities took place (workplace), using univariate and multivariate (age-adjusted) logistic regression analysis.

RESULTS

The survey was data derived from a sample of 632 mothers/caregivers. 62% of 0-23-month-old children received colostrum whilst only 31% of 0-5 months babies were on exclusive breastfeeding (EBF). Among 6-23 months old children, 17% consumed foods and beverages from at least five out of eight defined food groups, 31% received a minimum frequency of meals, and 23% had a minimum acceptable diet. Data revealed a positive correlation between early initiation of breastfeeding and delivery in a maternity ward (OR 6.9, CI 3.2-16.1, p-value < 0.001). No difference in the IYCF indicators between female and male babies was detected.

CONCLUSIONS

In the Namuno district, IYCF practices did not fulfill WHO/UNICEF's indicators and recommendations. This suggests that efforts should be focused on EBF-enabling interventions to improve children's dietary consumption patterns.

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

Background

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

Methods

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

Results

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

Conclusions

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

A non-linear decomposition analysis of children's dietary diversity scores: explaining rural-urban inequality

Sufficient and nourishing foods during the early years of a child's life are essential for optimal growth and healthy life. The existing disparities among rural-urban populations also affect the dietary pattern as well. Therefore, this study aims to identify the factors that contribute towards the rural-urban disparity in children's dietary diversity (CDD) and quantify their importance for the reduction of rural-urban disparities in achieving a minimum dietary diversity level. Using Pakistan Demographic and Health Survey (PDHS) data, version 2017-18, a non-linear decomposition analysis was performed. Eighty-one (81%) of the gap in CDD between rural-urban areas is attributed to the differences in the observed factors (endowments) and of these most of the difference is explained by three factors i.e. number of antenatal care visits (45%), maternal education (18%) and type of toilet facility (15%). There is a need to explore maternal education-related interventions to decrease the rural-urban gap regarding CDD as maternal education may affect CDD through different dimensions. Moreover, such programs should be initiated that may be helpful to enhance women's role in society, such as skilled education, well-paid job opportunities and better health facilities.

Feeding Patterns, Mother-Child Dietary Diversity and Prevalence of Malnutrition Among Under-Five Children in Lebanon: A Cross-Sectional Study Based on Retrospective Recall

Background

Despite demonstrated benefits, most countries fall short of meeting international targets for breastfeeding patterns, optimal complementary feeding, mother-children's quality diet, and malnutrition among under-five children.

Rationale

Since mothers usually play the most vital role in the healthcare of their children, research is needed to illuminate maternal factors that might promote a child's health and nutritional status.

Aim

The purpose of this study is to retrospectively (1) examine the under-five children's (0–59 months) feeding habits including exclusive breastfeeding, exclusive bottle feeding, continued breastfeeding, and complementary feedings, (2) investigate the mother-child's dietary diversity, and (3) identify any factors that cause less optimal nutrition due to a lack of food diversity in children aged 6 to 59 months. Moreover, (4) the prevalence of wasting, stunting, underweight, and overweight in the under-five offspring living in households located in the main two provinces in Lebanon (Beirut and Mount Lebanon) was determined.

Methods

The data for this analysis were collected from a representative sample of 384 households [384 mothers (21–49 years old) and children (0–59 months)] between February 2019 and June 2019. A questionnaire was used to inquire mothers of children ages 0–23 months about exclusive breastfeeding (EBF), continuous breastfeeding (CBF), exclusive bottle feeding (EBOT), mixed feeding (MF), and complementary feeding patterns. Moreover, additional questions regarding dietary diversity were asked to mothers of children aged 6 to 59 months. This score was calculated based on the 24 h recall of the mother and her child's consumption of 7 food groups, during the 24 h prior to the survey. Moreover, stunting, wasting, overweight, and underweight were calculated using the z-score for height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ), respectively. Binary logistic regression was used to explore the dietary diversity among children (ages 6–59 months) adjusting for covariates at maternal and household levels.

Results

Around 44% of children (0–59 months) had normal body weight. In addition, 9.3% were underweight (WAZ < -2SD to −3SD), 6.5% were at risk of being overweight, 24.45% were overweight, 9.3% were stunted (HAZ < -2SD to −3SD), and 6.25% (WHZ < -2SD to −3SD) were wasted. In total, among under-five children, the prevalence of EBF at 40 d and 6 months was 27 and 30%, respectively. The prevalence of CBF was 23%. Around 60% of mothers breastfed their offspring between 0 and 6 months and half of them introduced infant formula at earlier stages between 0–6 months. Furthermore, 78.4% of mothers introduced food to their children between 4 and 6 months (of which 40% before 6 months) and 62.5% of them introduced sugary drinks before 6 months. As for dietary diversity (DD), one out of two mothers and one out of three children (ages 6–59 months) had a low DD score (DDS) (46 and 32%, respectively). The children's and mother's DD were strongly found to be correlated (p-value = 0.034). Regression analysis showed that children's DD increased around 2 times [AOR = 1.7; 95% CI (1.042–2.914)] in context of high maternal DDS, and about 12 times [AOR = 11.7; 95% CI (1.2–111)] when a member of the highest-income households.

Conclusions

Our findings demonstrated low rates of EBF and CBF, high prevalence of EBOT, and early introduction of complementary foods among children ages 0–59 months. Furthermore, for children ages 6–59 months, there was poor mother-child dietary diversity and a high prevalence of overweight and stunted children in the main two Lebanese provinces. This suggests the alarming need for continuous nutrition intervention to improve infant feeding patterns and dietary diversity to reduce the malnutrition rates.

The effect of mothers and caregivers’ fasting status on the dietary diversity of children 6-23 months: A longitudinal study in Debrebirhan, Ethiopia

Background

There are various religions in Ethiopia, of which the Orthodox Tewahido Christian accounts for 44% of the population. According to the Ethiopian Orthodox Tewahido practice close to 200 days annually are dedicated to fasting. During this time, all followers who are above seven years old are expected to abstain from all types of food, including animal source foods and water for up to some hours daily. It is possible that such practice by mothers or caregivers could affect children’s dietary practice. However, whether mothers/caregivers’ fasting status influences dietary diversity of children during these periods remained uninvestigated.

Methods

A community-based longitudinal study was conducted in Debrebirhan, North Shewa Zone, Ethiopia in seven randomly selected kebeles. We collected data in a sample of 218 mothers/caregivers, from January 29 to February 25, 2019 in the pre-fasting period and from March 18 to April 10, 2019, during fasting period on same participants. Data was entered on Epi-Data version 4.4.2.1 and analyzed using STATA 15 software. Children’s dietary diversity was measured using the World Health Organization (WHO) standardized questionnaire for infant and young child feeding. The McNemar paired test was used for comparison of baseline and end line measurements. Statistical significance was set at p<0.05.

Result

A total of 218 and 216 mothers/caregivers with children 6–23 months participated in the study before and during fasting season with a response rate of 100.0% and 99.0% respectively. The median age of children was 14 months. The proportion of children who met the minimum dietary diversity before the fasting season was significantly higher (23.4%) compared to during the fasting period (5.5%). (P<0.001). The proportion of children who consumed dairy product was significantly higher (55.5%) before the fasting period compared to consumption during the fasting period (42.6%) (p<0.001). Similarly, consumption of flesh food was significantly higher before the fasting period (17.9%) compared to consumption during the fasting period (0.46%) (P<0.001).

Conclusion

The study revealed that mothers/caregivers’ fasting status negatively affect the dietary diversity of children aged 6–23 months in the household by decreasing their consumption of animal source food. Intervention strategies in promoting children’s dietary diversity should be designed in a way that considers Ethiopian Orthodox Tewahido Christian mothers/caregivers’ fasting practice.

Dietary behaviour and anthropometric parameters across the spectrum of pregnant and lactating mother, infant, young children, adolescent girls and reproductive age group females: An assessment of undernutrition among KOL tribe

Introduction

The Kol is an ancient tribal community, who resides in the backward Bundelkhand and Baghelkhand regions bordering UP and MP. Reports claim the high level of exploitation and marginalisation of them by feudal landed landlords. Due to the dearth of studies on Kol community their plight hasn't been addressed effectively so far. Thus, this study was undertaken to assess the dietary behaviour and anthropometric parameters across the spectrum of Maternal, Lactating, Infant, Young Children, Adolescent girls, and reproductive-age women (MIYC-AR) of Kol Community.

Methodology

It was a descriptive observational cross-sectional study, conducted over a period of 6 months; in hard to reach area of Manikpur block, Mangawa, in Chitrakoot district. Pregnant, lactating mothers, infant, young children, adolescent and reproductive age females who were found eligible, were included in the study. A total of 180 participants (30 from each group) were recruited by non-probability purposive sampling. A structured questionnaire was used to collect information regarding Iron folic acid and calcium intake, frequency of major meals and snacks, feeding history of infant and young child. Weight, height, head circumference and mid upper arm circumference were noted and the participants were classified accordingly. Statistical analysis was done using STATA version 13 software.

Results

Only 36% and 30% of the pregnant and lactating mother, respectively, consumed IFA and calcium. The mean diet diversity score was inadequate for all the groups. Maximum among adolescents (70%) and half of the reproductive age group female (50%) were underweight. More than half of the infants (57%) were found to be malnourished on MUAC measurement, while the similar proportion among young children were found to be normal (p < 0.001). Half of the young children had timely initiation of complimentary feeding. But, none among young children received Vitamin A syrup.

Conclusion

Significant higher prevalence of malnutrition was found among infants, adolescents, and reproductive age group females. Strengthening the public distribution system and rigorous supplementary nutrition services through ICDS are the priority intervention needed to address the poor nutritional status of tribe.

Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post‐natal combinations of lipid‐based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet‐based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age‐appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24‐h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non‐significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food‐secure and severely food‐insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

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

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

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.

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

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

Dietary Diversity Practice and Associated Factors among Children Aged 6-23 Months in Robe Town, Bale Zone, Ethiopia

Background

Diet diversification is essential to prepare adequate food that is useful for children's physical and cognitive development. Despite the limited studies performed in different parts of Ethiopia, the information about the feeding practice of children in the current study area is not documented. Thus, this study intended to assess the dietary diversity practices and associated factors among children aged 6-23 months.

Methods

Community-based cross-sectional study was conducted on 517 children aged 6-23 months paired with their mothers in Robe town. Systematic sampling technique was applied to select a child-mother pair. Data were collected using a pretested and structured questionnaire. Multivariate logistic regression analyses were used to identify the factors associated with the dependent variable. Adjusted odds ratios with 95% confidence interval were used to assess the strength of association and level of significance.

Results

From a total of 508 children included, making a 98% response rate, 77% of them did not meet the minimum dietary diversity. Children aged 12-23 months were more likely fed diversified food when compared with those aged 6-11 months (AOR = 2.99). Mothers whose educational level was secondary and above (AOR = 3.21), had media exposure (AOR = 3.99), and were knowledgeable about diet diversification (AOR = 8.5) were more likely to feed their child diversified food than their counterpart. Children whose father was a merchant were more likely to receive a diversified diet compared to those whose fathers were daily laborers.

Conclusions

Inadequate practices of minimum dietary diversity observed in the current study area were mainly associated with the child's age, maternal education, mothers' knowledge on diet diversification, and media exposure. Improving knowledge of mothers, increasing their education, and promoting appropriate infant and child feeding practices through media are an important intervention to improve dietary diversity practices.

Determinants of age-appropriate breastfeeding, dietary diversity, and consumption of animal source foods among Indonesian children

Global child feeding practices remain suboptimal. In this study, we assess the determinants of age-inappropriate breastfeeding, dietary diversity, and consumption of 3+ types of animal source foods (ASFs) using 11,687 observations from combined data from the Indonesian Demographic Health Survey of 2012 and 2017. We used linear and logistic regression after adjusting for the complex sampling design. Child's age and quality of antenatal care (ANC) were associated with all outcomes. Socio-economic status and labour force participation were positively associated with higher dietary diversity score, ASF consumption, and age-inappropriate breastfeeding. More ANC visits and having consultation at ANC were associated with more dietary diversity. Higher women's knowledge level was associated with more dietary diversity and consuming more ASF. Compared with western Indonesia, more children in eastern Indonesia were age-inappropriately breastfed and had lower dietary diversity. The Indonesian government needs to develop programmes to improve child feeding particularly in eastern Indonesia, focusing on improving dietary diversity and ASF consumption in poorer households and on prolonging breastfeeding in richer households. Women's labour force participation should be encouraged, but programmes for working mothers are also needed to support continued breastfeeding and to express breast milk. ANC and postnatal programmes need improved consultation sessions for child feeding.

Association of food security and other socio-economic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh

INTRODUCTION

Dietary diversity score (DDS) is a proxy indicator for measuring nutrient adequacy. In this study, we aimed to identify the nutritional statuses and current patterns of DDS among children between 6-59 months old and their associations with different individual and household level factors in rural Bangladesh.

METHODS

The Nobokoli programme of World Vision Bangladesh was implemented in Mymensingh, Sherpur, Rangpur, Dinajpur, Thakurgaon, Panchagar, and Nilphamari districts of Bangladesh between 2014 and 2017. A cross-sectional community household survey was administered between July and October 2014 to collect baseline data to evaluate the Nobokoli programme. A total of 6,468 children between 6-59 months old were included in the final analysis. Anthropometric data was collected following WHO guidelines on using wooden height and digital weight scales. We collected food intake information for the past 24 hours of the survey. The WHO's child growth standard medians were used to identify the nutritional indices of stunting, wasting, and underweight. Food items consumed were categorized into nine food groups and the DDS was constructed by counting the consumption of food items across these groups during the preceding 24 hour period. The association of DDS and nutritional status (stunting, wasting and underweight) with sociodemographic factors and household food security status were examined using multivariable models; linear regression and logistics regression respectively.

RESULTS

The prevalence of stunting, wasting and underweight among children aged 6-59months were 36.8%, 18.2% and 37.7% respectively. Our findings revealed that almost all children ate any form of starch followed by consumption of milk or milk products (76%) and fleshy meat /fish (61%) respectively. The mean DDS among children was 3.93(sd 1.47). Forty percent of the children obtained a DDS score less than 4. Multivariable analysis suggested that children whose mothers had higher educational attainment and are skilled workers had higher DDS (15% and 48% respectively) compared to their counterparts. The DDS showed strong positive association with household wealth status. Children from food secure households had 26% higher DDS compared to children from food insecure households. Similarly, increasing maternal education and household wealth were found to be protective against childhood stunting and undernutrition.

DISCUSSION

Our findings reiterate the need for improving household socioeconomic factors and household food security status for improving dietary diversity practices and nutritional status of children. Evidence-based solutions are needed to be implemented and expanded at scale to ensure appropriate dietary practices and improve nutritional status of the children in local context.

Status Sosial Ekonomi dan Keragaman Pangan Pada Balita Stunting dan Non-Stunting Usia 24-59 Bulan di Wilayah Kerja Puskesmas Wilangan Kabupaten Nganjuk

Background: Stunting is a chronic nutritional problem caused by poor nutritional intake and infectious diseases. Other causes are maternal socio-economic and nutritional conditions during pregnancy. Nutritional quality in food is influenced by the diversity of types of food consumed. Food diversity can be determined by prosperity, children's age, and mother's education. Economic conditions have a risk of stunting because they can describe the family's ability to fulfill nutritious food intake.Objective: This study aimed to analyze the relationship between socio-economic and food diversity with the incidence of stunting in children aged 24-59 months.Method: This study was an observational study with case control research design. The population in this study were children aged 24-59 months who were enrolled in Posyandu in the Puskesmas Wilangan working area. The sample size taken by each 28 toddlers was selected through simple random sampling. The food diversity score is obtained from the Individual Dietary Diversity Score (IDDS) score. Descriptive data analysis to describe toddler age, gender, mother's education, and mother's work. While inferential analysis used the chi-square test to determine the relationship between food diversity and income level with the incidence of stunting.Results:The results showed that family income was related to the incidence of stunting in infants (p = 0.048). Low family income is at risk of getting stunting. Scores of food diversity for stunting and non-stunting children are still low. The chi-square results show that there is no relationship between food diversity and the incidence of stunting (p = 1.000) and not a risk factor for stunting toddlers (OR = 1.000).Conclusion: Family income has a significant relationship with the incidence of stunting. Food diversity is not related to stunting.ABSTRAKLatar Belakang: Stunting adalah masalah gizi kronis yang disebabkan oleh asupan gizi yang kurang dan penyakit infeksi. Penyebab lain adalah kondisi sosial ekonomi dan gizi ibu saat hamil. Kualitas gizi pada makanan dipengaruhi oleh keragaman jenis pangan yang dikonsumsi. Keragaman pangan dapat ditentukan oleh kesejahteraan, usia anak, dan pendidikan ibu. Kondisi ekonomi memiliki risiko terjadinya stunting karena dapat menggambarkan kemampuan keluarga dalam memenuhi asupan makanan yang bergizi.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan antara sosial ekonomi dan keragaman pangan dengan kejadian stunting pada balita usia 24-59 bulan.Metode: Penelitian ini adalah jenis penelitian observasional dengan desain penelitian case control.  Populasi pada penelitian ini anak balita usia 24-59 bulan yang terdaftar dalam Posyandu wilayah kerja Puskesmas Wilangan. Besar sampel yang diambil masing-masing 28 balita yang dipilih melalui simple random sampling. Skor keragaman pangan diperoleh dari skor Individual Dietary Diversity Score (IDDS). Analisis data secara deskriptif untuk menggambarkan usia balita, jenis kelamin, pendidikan ibu, dan pekerjaan ibu. Sedangkan analisis inferensial menggunakan uji chi-square untuk mengetahui hubungan keragaman pangan dan tingkat pendapatan dengan kejadian stunting. Hasil: Hasil penelitian menunjukkan pendapatan keluarga berhubungan dengan kejadian stunting pada balita (p=0,048). Pendapatan keluarga yang rendah berisiko terkena stunting. Skor keragaman pangan pangan balita stunting maupun non-stunting sama-sama masih rendah. Hasil chi-square menunjukkan bahwa tidak ada hubungan antara keragaman pangan dengan kejadian stunting (p=1,000) dan bukanlah faktor risiko balita stunting (OR = 1,000).Kesimpulan: Pendapatan keluarga memiliki hubungan yang signifikan dengan kejadian stunting. Keragaman pangan tidak berhubungan dengan stunting.

Determinants of stunting, underweight and wasting among children < 5 years of age: evidence from 2012-2013 Pakistan demographic and health survey

BACKGROUND

Childhood malnutrition is a critical public health concern in Pakistan. We aimed to explore factors associated with malnutrition in Pakistani children (< 5 years of age) using the Pakistan Demographic and Health Survey (PDHS) 2012-2013.

METHODS

Sample of 3071 Pakistani children aged 0-59 months from the PDHS 2012-2013, with complete anthropometric measurements were included in the study. Nutritional status was evaluated using anthropometric indices; height-for-age, weight-for-height and weight-for-age, as proxy measures of three forms of under-five malnutrition including stunting, wasting and underweight respectively. Uni- and multivariate binary logistic regressions were used to examine the association between selected maternal-socio-demographic and child level variables (such as child sex, age, size at birth, antenatal clinic visits, recent diarrheal incidence and breastfeeding status) and three proxy measures of child nutritional status.

RESULTS

About 44.4% of under-five children were stunted, 29.4% were underweight and 10.7% were wasted. Children whose mothers lived in rural areas (aOR = 0.67, 95%CI 0.48-0.92), were aged ≥18 years at marriage (aOR = 0.76, 95%CI 0.59-0.99) and had visited antenatal clinic more than 3 times during pregnancy (aOR = 0.61, 95%CI 0.38-0.98) were less likely to be stunted. Mother's low educational level (aOR = 2.55, 95%CI 1.26-5.17), short stature (aOR = 2.31, 95%CI 1.34-3.98), child's small size at birth (aOR = 1.67, 95%CI 1.14-2.45) and mother's BMI were significantly associated with child's underweight status. Children whose mothers had no education were more likely to be wasted (aOR = 3.61, 95%CI 1.33-9.82).

CONCLUSION

The study suggests that most of the analysed factors that accounted for malnutrition in Pakistani children (such as mother's age at marriage, educational level and mothers' nutritional status) are preventable. Therefore, to reduce the burden of malnutrition interventions that can address these factors are required such as community based education and targeted nutritional interventions.

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.

Keragaman Pangan dengan Status Kadarzi Keluarga di Wilayah Kerja Posyandu Sidotopo, Surabaya

Background: Indonesia still facing some nutritional problems that hinder its economics development. The government itself has an effort to tackle nutritional problems by establishing  a program known as Keluarga Sadar Gizi (Kadarzi). The family expected to understand and overcome the nutritional problems affecting its members. One of Kadarzi’s five indicator is dietary diversity. Dietary divesity can reflected dietary quality. Therefore, dietary diversity assessment is influential to improve dietary quality. Objectives: The purpose of this study was to analyze the differences in dietary diversity scores among Kadarzi household. Method: The design of the study was cross sectional. Number of sample were 34 mothers who registered in Posyandu settled in Kelurahan Sidotopo, Kecamatan Semampir, Kota Surabaya. Samples were selected using simple random sampling technique. Kadarzi data were collected from KMS book. Dietary diversity was assessed using Individual Dietary Diversity Score (IDDS). The data were analyzed using independent T-test. Result: The result showed that most families were not meeting Kadarzi’s indicator (73%). There were 32.4% family categorized as low dietary diversity, 47.1% family categorized as medium dietary diversity, and 20.6% family categorized as high dietary diversity. There were a difference of dietary diversity score beetwen Kadarzi’s household nor Kadarzi’s household (p<0.001). In Kadarzi’s household the consumption of dark green leafy vegetables, other vitamin A rich fruits and vegetables, anf other fruits and vegetables are higher than non Kadarzi’s household. Conclusions: There was a significant difference in dietary diversity score beetwen Kadarzi’s household and nor Kadarzi’s household. The importance of eating diverse and some references of affordable food choice to meet dietary diversity were needed to share.ABSTRAKLatar belakang: Indonesia masih menghadapi beberapa masalah gizi yang menghambat perkembangan ekonomi. Namun pemerintah memiliki suatu upaya untuk mengatasi permasalahan gizi tersebut dengan membentuk program Keluarga Sadar Gizi (Kadarzi). Pada program ini keluarga diharapkan mampu mengerti dan mengatasi permasalahan gizi anggotanya. Salah dari lima perilaku Kadarzi adalah makan beragam. Makan beragam merupakan salah satu perilaku yang dapat menggambarkan kualitas diet individu. Oleh karena itu penilaian keragaman pangan perlu diketahui untuk mengetahui dan meningkatkan kualitas diet individu. Tujuan: Tujuan penelitian ini adalah untuk menganalisis perbedaan skor keragaman pangan pada keluarga sadar gizi. Metode: Penelitian observasional ini disusun dengan rancang bangun cross sectional. Sejumlah 34 sampel yang merupakan ibu balita yang terdaftar di Posyandu di wilayah Kelurahan Sidotopo, Kecamatan Semampir, Kota Surabaya dipilih menggunakan teknik simple random sampling. Data Kadarzi didapatkan dari observasi kartu menuju sehat (KMS). Keragaman pangan dinilai menggunakan instrumen Individual Dietary Diversity Score (IDDS). Data dianalisis menggunakan independent T-test. Hasil: Sebagian besar keluarga masih belum menerapkan perilaku Kadarzi (73%). Sebanyak 32,4% keluarga termasuk dalam kategori skor keragaman pangan rendah, 47,1% dalam kategori sedang, dan 20,6% dalam kategori tinggi. Terdapat perbedaan skor keragaman pangan antara keluarga yang menerapkan perilaku Kadarzi dan tidak menerapkan perilaku Kadarzi (p<0,001). Pada keluarga yang menerapkan perilaku Kadarzi konsumsi sayuran hijau, sayur dan buah vitamin A, sayur dan buah yang lain lebih tinggi daripada keluarga yang tidak menerapkan Kadarzi. Kesimpulan: Terdapat perbedaan skor keragaman pangan antara keluarga yang menerapkan perilaku Kadarzi dan tidak menerapkan perilaku Kadarzi. Diperlukan pemaparan informasi lebih lanjut mengenai pentingnya makan beragam dan pemilihan makanan yang terjangkau untuk dapat memenuhi konsumsi makan beragam.