Responsive Feeding Is Associated With Minimum Dietary Diversity in Rural Areas of Peru, Nicaragua and Indonesia

Abstract

ObjectivesResponsive feeding, the age and developmentally appropriate interactions between caregivers and their infants and young children (IYC) 6–23 months, is a critical component of complementary feeding to promote healthy growth and development. Survey questions were developed to represent four dimensions of responsive feeding: 1) opportunities for child self-feeding, 2) talking positively with the child during mealtime, 3) encouraging a child who has not eaten enough, and 4) appropriate response to child refusal (ProPAN, PAHO, 2013). In this study we examined responsive feeding, dichotomized as high or low, and its association with the IYC WHO indicator minimum dietary diversity (MDD) in three countries: Peru, Nicaragua and Indonesia. MethodsCross-sectional surveys were administered by trained enumerators as part of a program evaluation to a random sample of households with IYC 6–23 months in largely rural, poor areas of Peru, Nicaragua and Indonesia where malnutrition was prevalent. Among the topics included were responsive feeding, dietary intake, health and demographics. From a possible score of -1 to + 4, low responsive feeding was considered -1 to 2 and high responsive feeding 3 to 4. Analysis by country included descriptive statistics of responsive feeding by IYC age group and generalized linear models with a logit link. ResultsAmong the sample of 2273 IYC, the proportion of caregivers with high responsive feeding scores were similar across countries: 26.5% in Indonesia, 31.6% in Nicaragua and 30.6% in Peru. When examined by age group, a larger percentage of younger IYC (6–8 months) had higher responsive feeding scores than older age groups (9–11 and 12–23 months) across countries. MDD differed considerably by country: 92.1% in Peru, 52.1% in Nicaragua, and 17.1% in Indonesia. In country specific multivariate models, high responsive feeding was associated with achieving MDD in all three countries, controlling for child age and other variables. ConclusionsResponsive feeding is an important component of complementary feeding and these results suggest a positive association between responsive feeding and MDD in three diverse settings. These results provide promising evidence to encourage interventions that promote responsive feeding as part of key feeding practices for caregivers of IYC. Funding SourcesCARE USA; Sigma Theta Tau International.