Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014.

Muzi Na,Bikash Lamichhane,Mary Arimond,Christine P Stewart,Víctor M Aguayo,Rajkumar Pokharel,Stanley Chitekwe,Pradiumna Dahal

doi:10.1111/mcn.12564

Abstract

There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6–23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO‐UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community‐level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children.

Highlights

South Asia has achieved significant progress in reducing child undernutrition, with a decline in the prevalence of stunting in children under five from 56% to 36% in the past 2 decades (Stevens et al, 2012)
Using nationally representative data from Nepal, this paper focuses on the time trends and predictors of four core WHO‐UNICEF complementary feeding indicators that assess the timely introduction of complementary foods, the frequency of feeding, the diversity of foods, and the overall adequacy of diets among Nepali children aged 6–23 months using survey data collected from 2001 to 2014
Using nationally representative data from four survey years, we examined time trends and independent predictors of appropriate complementary feeding practices in Nepal from 2001 to 2014

Summary

| INTRODUCTION

South Asia has achieved significant progress in reducing child undernutrition, with a decline in the prevalence of stunting in children under five from 56% to 36% in the past 2 decades (Stevens et al, 2012). Using nationally representative data from Nepal, this paper focuses on the time trends and predictors of four core WHO‐UNICEF complementary feeding indicators that assess the timely introduction of complementary foods, the frequency of feeding, the diversity of foods, and the overall adequacy of diets among Nepali children aged 6–23 months using survey data collected from 2001 to 2014. The specific aims of the study are (a) to examine time trends in each of the four complementary feeding indicators in all and within subgroups of children; (b) to investigate time trends in food group consumption in children by child age and by survey month; and (c) to identify factors at the individual, household, and community levels that are related to positive complementary feeding practices. Despite rapid improvement in health and development indicators, slow progress has been made in complementary feeding practices in the past 15 years in Nepal with average annual rate of increase ranged from 1% to 2% per year. According to the WHO definitions (World Health Organization, 2010), we have defined the four complementary feeding indicators as follows:

| METHODS

| RESULTS

| DISCUSSION

Findings

CONFLICTS OF INTEREST