“When,” “What,” and “How” of complementary feeding: A mixed methods cross-sectional study from a rural medical college in central India

Abstract

Background and Aim: Undernutrition among under-five children is one of the most important public health problems in India. Despite several years of efforts to tackle undernutrition, India has not been able to make any significant dent on proportion of undernutrition. The aim of this study is to assess the quality of complementary feeding (CF) practices among mothers visiting immunization clinic of a rural medical college in central India. Materials and Methods: This hospital-based study was conducted among 190 consecutively recruited children between 6 and 23 months of age who visited the immunization clinic. Study design involves cross-sectional study using mixed methods. Sociodemographic details were recorded and anthropometric measurements were done using calibrated infantometer and electronic weighing scale. The adapted CF index (CFI) was administered that included questions on continuation of breast-feeding, initiation of CF, dietary diversity, food frequency, and responsive feeding. Freelisting was conducted with 20 different mothers. Calorific value of CF given was determined based on 24-h dietary recall. Results: The magnitude of underweight, stunting, and wasting was 25.8%, 27.9%, and 10%, respectively. Almost all (91.6%) of the children had received timely initiation of CF, but only 67.4% children had received dietary diversity and 75.5% of nonbreast fed and 77.7% of breast fed children received appropriate meal frequency. The CFI and calorific value of food had significant positive correlation. CFI score was significantly associated with stunting (Prevalence odds ratio (POR) 8.37, 95% Confidence interval: 1.09–64.2). The findings of CFI triangulate with findings of freelisting. The study participants showed poor intake of flesh foods (meat and eggs) and Vitamin-A rich fruits and vegetables. Starchy staples and other fruits were consumed more readily. Conclusion: CFI helps to readily assess the quality of CF. Complementary feeds given were not adequate in terms of minimum dietary diversity, meal frequency, and provision of required calories and protein.