Abstract
Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi‐solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6–8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6–23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community‐level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda.
Highlights
Afghanistan has been in near constant conflict, political instability, and economic downturn since the 1970s, (Wieser, Rahimi, & Redaelli, 2017), with a Human Development Index ranking at 169/188 in the world on the basis of indicators of life expectancy, education, and per capita income (United Nations Development Programme, 2016)
Maternal education was not significantly associated with INTRO or minimum acceptable diet (MAD); maternal primary education was associated with a greater odds of meeting minimum meal frequency (MMF) and maternal secondary education or higher was associated with a greater odds of meeting minimum dietary diversity (MDD) compared with children of mothers without formal education
Our sensitivity analyses revealed similar odds ratio (OR) in models with child sex, maternal age, paternal age, and household wealth fixed as covariates, with nonbreastfed children included in the analysis of MDD, with type of delivery assistance variable included, and with bootstrapping analysis adjusting for potential bias of nonnormality of the statistics being estimated
Summary
Afghanistan has been in near constant conflict, political instability, and economic downturn since the 1970s, (Wieser, Rahimi, & Redaelli, 2017), with a Human Development Index ranking at 169/188 in the world on the basis of indicators of life expectancy, education, and per capita income (United Nations Development Programme, 2016). Stunting among children aged 0–59 months declined by 30%, from 59% in 2004 (World Bank, 2017) to 41% in 2013 (Afghanistan Ministry of Public Health & UNICEF, 2013). Despite this decline, the prevalence of child stunting remains unacceptably high, as two in five children under five have stunted growth and 1 in 5 are severely stunted (Higgins‐Steele et al, 2016). We analysed data collected by the 2015 Afghanistan Demographic and Health Survey (AfDHS; CSO et al, 2017), which provided up to date information on child feeding practices from a large nationally representative sample of infants and young children aged 0–23 months. Our study aims to identify priority areas of focus for future policies, strategies programs aiming to improve the quality of complementary foods and feeding practices among Afghan children
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