Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children.

Jill R Wormer,Arti Shankar,Wilco C W R Zijlmans,Maureen Y Lichtveld,Ashna D Hindori-Mohangoo,Hannah Covert,Michael Boele Van Hensbroek

doi:10.3390/ijerph182010739

Abstract

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10–33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37–0.74, p < 0.001; OR 0.55; 95%CI: 0.39–0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.

Highlights

Significant progress has been made in reducing under-five mortality
Due to delayed recruitment and data collection of the logistically difficult-to-reach participants in the Surinamese interior, a total of 799 Surinamese mother–child dyads were included in the current analysis
Our findings suggest that minimum dietary diversity (MDD) and minimum acceptable diet (MAD) are significantly associated with upper respiratory tract infections

Summary

Introduction

Significant progress has been made in reducing under-five mortality. Globally, the mortality rate declined from 93 deaths per 1000 live births in 1990 to 38 deaths in 2019 [1].In Suriname, a middle-income country in South America, the under-five mortality rate was estimated at 18 deaths per 1000 live births in 2019, which is higher than the Latin American and the Caribbean average [2]. Significant progress has been made in reducing under-five mortality. The mortality rate declined from 93 deaths per 1000 live births in 1990 to 38 deaths in 2019 [1]. In Suriname, a middle-income country in South America, the under-five mortality rate was estimated at 18 deaths per 1000 live births in 2019, which is higher than the Latin American and the Caribbean average [2]. Despite the progress that has been made in reducing under-five mortality, the global burden of under-five deaths remains unacceptably high [1]. Acute RTIs are ranked among the leading causes of under-five mortality in developing countries. In 2013, the WHO estimated 9% of all under-five deaths in Suriname to be attributable to RTIs [3]. Numerous studies revealed striking intercountry and regional disparities in the occurrence of acute RTIs, and child survival outcomes associated with

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