Infant and young child feeding (IYCF) practices and nutritional status under 2 years of age in Bhutan

Abstract

In South Asia, while childhood undernutrition persists, overweight is gradually becoming common. IYCF practices (e.g., exclusive breastfeeding, timely complementary feeding, diet diversity) promote healthy growth, but little is known about IYCF and their link to children's nutritional status in Bhutan, explored here in data collected during the 2015 Bhutan National Nutrition Survey. In this nationally‐representative survey, household (HH) membership and socioeconomic status (SES), youngest preschool child anthropometry and derived WHO/UNICEF IYCF indicators were assessed. IYCF and anthropometry data were available for 441 children < 24 mo of age. Length‐for‐age (LAZ), weight‐for‐length (WLZ) and weight‐for‐age (WAZ) Z‐scores were derived relative to the WHO reference. 15%, 5% and 12% of children were stunted, wasted and underweight (< −2 Z), respectively, while 6% were overweight (WLZ > 2). HH assets owned (e.g., TV, 66% and sofa set, 28%) reflected an SES above neighboring Nepal and Bangladesh, but 40% of mothers had no schooling. Exclusive breastfeeding (BF) to 6 mo was reported by 52% of mothers and 92% and 61% reported continuing breastfeeding through the 1st and 2nd years, respectively. Timely introduction of complementary foods was reported for 93%, while only 18% of children met the minimum dietary diversity cutoff (≥ 4 food groups in past 24 hrs). Survey design‐adjusted regression analysis suggested girls were far less likely than boys (referent) to be exclusively breastfed under 6 mo of age: OR=0.2 (95% CI: 0.1–0.9). SES was associated with complementary feeding diet quality: ORs of reaching minimum dietary diversity were 5.3 (1.1–25.2) and 7.8 (1.3–46.9) in HHs classified into the 4th and 5th vs 1st quintiles of a wealth index. No IYCF indicator was associated with stunting or wasting, while exclusive and predominant BF < 6 mo and continued BF to 2 years were protective against overweight (OR=0.1 (0.0–1.0), 0.1 (0.0–0.6) and 0.0 (0.0–0.4), respectively). Acceptable breast and complementary feeding practices along with low rates of under‐ and over‐nutrition suggest a situation of moderately low nutritional risk, but sex differences in breastfeeding practices, protective effects for overweight of BF according to guidelines and close associations between SES and complementary food quality suggest directions for potential programmatic interventions.Support or Funding InformationUNICEF Regional Office for South Asia, Kathmandu, Nepal