Quality of the Early Infant Diet across the Eight Low and Middle Income Countries from the Malnutrition and Enteric Disease (MAL‐ED) Study

Abstract

We explored breastfeeding practices and the quality of the early complementary feeding from birth to eight months of age according to WHO core indicators across the eight sites in South Asia (Bangladesh, India, Nepal and Pakistan), Africa (South Africa, Tanzania) and Latin America (Brazil, Peru). We prospectively follow up cohorts of ~200 mother‐newborn dyads at each site. We categorized exclusive breastfeeding and the quality of the complementary feeding utilizing the WHO Core Indicators by twice weekly surveillance visits and monthly food frequency survey. Overall, 2145 children were enrolled across eight sites. By six months of age, exclusive breastfeeding rates ranged from 1 to 4% in India, Nepal, Brazil, and Peru to 10.3% in Bangladesh. No children in Pakistan, South Africa, or Tanzania were EBF for their entire first six months of life. Only Brazil had acceptable minimum diet diversity (72.2%), acceptable diet (70.5%), meal frequency (90%) and consumption of iron rich foods (71%), while in all sites it ranged from 4‐15%, 0‐14%, 11‐95% and 3‐44%, respectively. Exclusive breastfeeding in the first 6 months and quality of complementary foods at 6‐8 months of age were heterogeneous and sub‐optimal in most of the sites.