Abstract
Age-appropriate feeding practice (ADF) during early childhood are vital for optimal nutrition. This longitudinal study determined the effect of selected risk factors and ADF, as described by the National Nutritional Recommendations, on linear and ponderal growth of children below 24 months of age. Weight and length measures were used to calculate z-scores of anthropometric measures by WHO standards. The prevalence of stunting increased from 13.2% to 32.4% over time, while prevalence of wasting remained stable (14.5%). At first visit, 43% of children of all ages complied with ADF criteria, a proportion which decreased to 7.1% in follow-up. The quality of feeding practices for children above 12 months of age was the poorest, where at the last visit, only 6% complied with the criteria for ADF. The linear mixed-effect models found the association between ADF and ponderal growth to be significant (weight-for-height estimate: 0.05 SD). In Cambodia, Ratanakiri province, ADF was the second largest determinant for ponderal growth. We recommend province specific public health actions. For children above 6 months, the quantity of food given needs to be increased, followed by the meal frequency. Mothers’ educational level, improved sanitation, and drinking water quality were among strongest predictors of a child’s growth.
Highlights
Malnutrition in the first five years of life, indicated by the presence of stunting or wasting, is associated with life-threatening consequences, as well as has a negative impact on physical and cognitive development [1,2,3,4]
To estimate the impact of appropriate feeding of the child over an age-span from exclusive breastfeeding through the complementary feeding period to a family diet, on the occurrence of malnutrition, we created the indicator for Appropriate Daily Feeding (ADF)
In Phnom Penh, we would recommend future public health actions to promote breastfeeding practice, including the promotion of an appropriate number of breastfeeding sessions. This could be especially relevant for lower educated mothers. In both Kratie and Ratanakiri, our study suggests that improvements in the quantity of complementary foods would improve the overall adherence to ADF
Summary
Malnutrition in the first five years of life, indicated by the presence of stunting or wasting, is associated with life-threatening consequences, as well as has a negative impact on physical and cognitive development [1,2,3,4]. These two forms of undernutrition—wasting and stunting—together with vitamin deficiencies and intrauterine growth restrictions were estimated in 2011 to account for. In Cambodia, poor infant and young child feeding practices together with low maternal education level, poverty, and a predominantly rural population were found to be main contributors to the poor nutritional status of children under five years of age [5]
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