Abstract
Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in Pakistan. Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0-2 years and/or their families. Search terms: 'children', 'feeding' and 'Asians' with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence). From 45 712 results, seventeen studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF was found in all studies. Nine of fifteen studies assessing timing recorded CF introduced between 6 and 9 months. Five of nine observed dietary diversity across four of seven food groups; and two of four, minimum meal frequency in over 50 % of participants. Influencing factors included lack of CF knowledge, low maternal education, socio-economic status and cultural beliefs. This is the first systematic review to evaluate CF practices in Pakistan. Campaigns to change health and nutrition behaviour are needed to meet the substantial unmet needs of these children.
Highlights
Introduction tocomplementary feeding (CF): 10 % with cereal, 30 % fruits, 10 % cow’s milk
Of the 45 712 studies identified, seventeen studies focusing on complementary feeding practices (CFP) in Pakistan were included in the current systematic review
Factors associated with complementary feeding practices We identified several factors influencing CFP
Summary
The present review (PROSPERO registration number CRD42014014025) summarizes publications on CFP in SA families in Pakistan only, with concurrent reviews summarizing publications on CFP in SA families in India(18), Bangladesh(19) and high-income countries (L Manikam, R Lingam, I Lever et al, unpublished results), respectively. Study selection and data extraction In total, 45 712 titles and abstracts were screened against inclusion criteria Two reviewers assessed these papers independently and conflicts were resolved by discussion with the team. Data were extracted by a single reviewer using a piloted modified worksheet including: country of study; study type; study year; study objectives; population studied, eligibility criteria and illness diagnosis; study design; ethical approval; sampling; data collection and analysis; feeding behaviours; adequacy of CFP; timing of initiation of CF; bias; value of the research; and weight of evidence. The evidence reviewed is presented as a narrative report, with the results categorized following IYCF indicators on: (i) adequacy of CFP, comprising dietary diversity, consumption of Fe-rich foods, meal frequency, timing of introduction of CFP, food hygiene and sources of advice for feeding; and (ii) barriers/promoters influencing CFP.
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