A child feeding index is superior to WHO IYCF indicators in explaining length-for-age Z-scores of young children in rural Cambodia

Anika Reinbott,Judith Kuchenbecker,Johannes Herrmann,Irmgard Jordan,Ellen Muehlhoff,Ou Kevanna,Michael Krawinkel

doi:10.1179/2046905514y.0000000155

Abstract

Background:Adequate young child feeding practices are influenced by a multitude of factors which affect growth and development. A combination of indicators is needed to explain the role of complementary feeding practices in growth retardation.Methods:A cross-sectional nutrition baseline survey was conducted in rural Cambodia in September 2012. Villages in pre-selected communes were randomly selected using stunting as a primary indicator. Data were collected from 803 randomly selected households with children aged 6–23 months, based on a standardised questionnaire and on length/height and weight measurements of mother and child. WHO Infant and Young Child Feeding (IYCF) indicators [minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD)] and a child feeding index (CFI) were created. The latter consisted of five components: breastfeeding, use of bottle, dietary diversity, food frequency and meal frequency which were adjusted for three age groups: 6–8, 9–11 and 12–23 months. The highest possible score was 10. Associations between length-for-age Z-scores (LAZ) and WHO indicators or CFI were explored.Results:Mean (SD) LAZ was −1·25 (1·14) (n = 801). Mean (range) CFI was 6·7 (1–10) (n = 797). Mean CFI was highest in the 9–11-months age group (7·93) and lowest for those aged 12–23 months (5·96). None of the WHO IYCF indicators was associated with LAZ, whereas CFI showed significant association with LAZ (P < 0·01). The association between higher CFI scores and LAZ became weaker as age increased.Conclusion:The results highlight the need to include a wide range of information in the analysis in order to understand the association between appropriate infant feeding practices and child growth.

Highlights

The Infant and Young Child Feeding (IYCF) indicators for children aged 6–23 months suggested by the World Health Organization (WHO) include minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum adequate diet (MAD).[12]
A pooled demographic and health surveys (DHS) analysis from 14 countries showed that non-achieved minimum acceptable diet (MAD) was found to be significantly associated with stunting in children aged 6–23 months whereas there was no relationship between subnormal MMF and stunting.[10]
The Food and Agriculture Organization (FAO) project includes a component of nutrition education on infant and young child feeding practices linked with components on improving farming systems and building up market links to increase and diversify production, and improve food security amongst smallholding farmers

Summary

Background

Adequate young child feeding practices are influenced by a multitude of factors which affect growth and development. WHO Infant and Young Child Feeding (IYCF) indicators [minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD)] and a child feeding index (CFI) were created. The latter consisted of five components: breastfeeding, use of bottle, dietary diversity, food frequency and meal frequency which were adjusted for three age groups: 6–8, 9–11 and 12–23 months. Conclusion: The results highlight the need to include a wide range of information in the analysis in order to understand the association between appropriate infant feeding practices and child growth. IYCF infant and young child feeding LAZ length-for-age Z-score MDD minimum dietary diversity MMF minimum meal frequency MAD minimum acceptable diet WAZ weight-for-age Z-score; WLZ weight-for-length Z-score

Introduction

Methods

Results

Discussion