Simultaneous analysis of feeding practice indicators during childhood diarrhea in Malawi

Abstract

Knowledge about factors associated with feeding practices during childhood diarrhea is an important precondition for development of diarrhea disease intervention strategies. The aim of this study was to find out determinants of giving more food and fluids to children with diarrhea while using simultaneous equations logit model. The study used 3402 records of 2015-16 Malawi demographic health survey under-five children's data who had diarrhea. Separate single outcome and simultaneous two outcome logistic regression models were fitted to two feeding practice binary indicators, giving fluids and food to children with diarrhea. The two models were compared using Akaike information criterion (AIC) and Bayesian information criterion (BIC). The AIC (fluids: 3807.859, food: 2432.310) and BIC (fluids: 3904.434, food: 2528.885) for separate outcome models were smaller than AIC (5805.826) and BIC (6095.550) for the simultaneous equations model. Nevertheless, the measure of dependency between giving fluids and food from simultaneous equations model showed strong dependency (OR: 11.7436, 95% CI: (9.125, 15.113)), suggesting a natural adoption of this model. The independent determinants of giving more fluids were rural residence (OR: 1.358, 95% CI: (1.055, 1.749), P-value: 0.018), higher education (OR: 2.882, 95% CI: (1.434, 5.796), P-value: 0.003), richest family ((OR: 1.509, 95% CI: (1.111, 2.049), P-value: 0.008), currently married (OR: 1.678, 95% CI: (1.109, 2.540), P-value: 0.014) and married before (OR: 2.145, 95% CI: (1.355, 3.395), P-value: 0.001). Rural residence (OR: 1.535, 95% CI: (1.085, 2.171), P-value: 0.015), sex of the child (OR: 0.773, 95% CI: (0.626, 0.954), P-value: 0.017) and richest family (OR: 1.960, 95% CI: (1.309, 2.932), P-value: 0.001), were significant determinants of offering more food. Strategies to improve feeding practices during childhood diarrhea should focus on improving maternal education and income. In addition, the focus should be on mothers in urban areas, those who are not married and educating parents about importance of a girl child.