Child Complementary Feeding Practices Research Articles

Impact of Training Program to Nurses Regarding Complementary Feeding in Infant and Young Children: An Educational Interventional Study

Introduction: Under nutrition is an underlying cause of more than one third of global deaths in children below the age of 5 years. Nutrition education is a critical strategy of intervention to improve child complementary feeding practices which will subsequently decrease mortality and morbidity of under-5 children.
 Objective: To determine the knowledge of nurses on complementary feeding practices and also provide appropriate training and verify its effectiveness.
 Method: It is a hospital based educational interventional study. The time-series was from October 2021 to march 2022 included 24 nursing staff. The nurses underwent one-day training on complementary feeding practices in infant. They were evaluated periodically on their knowledge at four different time points. The effectiveness of training was calculated based on the change in scores, as per mean numeric scores, immediately, 1 and 6 months after the training.
 Result: The nurses showed high competence by obtaining above average scores (100%) by all participant immediately after training and remained so after 1 month. The mean test score obtained before training was 15.3 which increased to 23 after training, 21.9 after 1 month and 17.8 after 6 months of training. The differences in mean were statistically significant (p value 0.000).
 Conclusion: This training intervention improved knowledge of nurses regarding complementary feeding practices, but improvements need to be strengthened and sustained.

Determinants of Complementary Feeding Indicators: A Secondary Analysis of Thailand Multiple Indicators Cluster Survey 2019.

Child complementary feeding (CF) practices meet dietary recommendations more often among educated, high-income groups. Much of the evidence for this association addresses inadequate CF for addressing child undernutrition. However, in many countries, including Thailand, child malnutrition assessments must now address under- and over-nutrition. More comprehensive data is needed to understand this complex situation. This study uses data from the Thailand Multiple Indicators Survey 2019, to identify the determinants of CF practices among 6–23-month children (n = 4125) using the newly developed WHO indicators. Logistic regression analysis was used to measure associations between sociodemographic factors and CF practices. In a fully adjusted model, child age, primary caregivers’ education, and household incomes were statistically associated with (in)appropriate CF practices. Older children aged 9–23 months, not only have better minimum dietary diversity (MDD), minimum acceptable diet (MAD), and egg and/or flesh food consumption (EFF), but also tend to consume more unhealthy foods. The proportion of inappropriate CF practices was higher among children living with caregivers other than their mothers. While maternal education and household income were positively associated with MDD and MAD, children of mothers from middle-class households consumed more sweetened beverages. Therefore, nutrition programs addressing different feeding problems should be developed specifically for different primary caregiver and demographic groups.

Study of nutritional status and feeding practices in under five children from Solapur city

Background: In spite of various nutrition programs, burden of malnutrition is still high in India. Therefore, it is necessary to find out the gaps in community. Objective was to study the proportion of malnutrition and its association with some of the socio-demographic factors and also to study the trends of complementary feeding practices in children from 0 to 5 years attending UHTC OPD.Methods: This is a cross-sectional study conducted in 146 children under 5 years attending UHTC OPD during a study period of 2 months.Results: There were 70.55% of participants having malnutrition. About 15.75% children were severely acute malnourished. About 75.34% mothers received advice about breast feeding and complementary feeding. Exclusively breastfed infants were 48.63% and 52.05% infants were started complementary feeding on time. Only 25.34% were eating food from ≥4 groups and 74.65% children received <4 food groups.Conclusions: Efforts are needed to promote exclusive breastfeeding and age-appropriate complementary feeding among infants.

Complementary feeding practices in children aged 6-23 months: An institution-based observational study

Background: Inappropriate complementary feeding practices in children may lead to adverse consequences ranging from growth failure to mortality. Intervention programs intending to optimize the practices should be based on identification of the lacunae and on the assessment of the magnitude of the problem. Aim: The aim of the study was to determine appropriateness and adequacy of complementary feeding given to children aged 6?23 months. Materials and Methods: Data regarding demographic profile, maternal education, source of information for feeding, and details of complementary feeding provided in the last 24 h were obtained from caregivers, using the standard WHO questionnaire. Chi-square test was used for determining the association between optimal feeding practices and continued breastfeeding, age-group, maternal education, and source of information. Results: The study enrolled 480 children (mean age: 12.9+5.1 month; male: female=1.22:1). 225 children (46.87%) had minimum meal frequency and 66 (13.8%) had minimum dietary diversity, 41 (11.08%) were receiving minimum acceptable diet. Only 103 mothers (21.5%) obtained the information regarding recommended complementary feeding practices from health professionals. There was a significant association between health professional being the source of information and presence of adequate dietary diversity (p<0.01) and minimum acceptable diet (p<0.01). Conclusion: Complimentary feeding practices are inadequate and thus, require an intervention of healthcare providers with better involvement.

The association between agricultural conditions and multiple dimensions of undernutrition in children 6-23 months of age in Burkina Faso

Background. The quality and quantity of food available to children affect their nutritional status, with implications for long-term health and development. In Burkina Faso, households rely on rainfed agriculture, but climate change is making crop production unreliable. We explore spatial patterns of growing season quality on dimensions of nutritional status and complementary feeding practices in children 6–23 months. Methods. The 2017 Performance Monitoring and Accountability 2020 (PMA2020) nutritional survey was spatially integrated with a contemporaneous remotely sensed drought indicator, the Water Requirement Satisfaction Index (WRSI), which captures local anomalous growing season conditions. Multi-level mixed-effects logistic regression models were estimated to explore the effects of WRSI on child mid-upper arm circumference (MUAC) score (indicating malnutrition), and two components of complementary feeding practices, adjusting for demographic and household characteristics. Results. The data set included 1,721 children. Higher WRSI values (better agricultural conditions and crop performance) were associated with 3% lower odds of malnutrition (Odds Ratio (OR) = 0.971; 95% confidence interval (CI): [0.942, 1.00]) and 7% higher odds of a child attaining minimum dietary diversity (OR = 1.07; 95% CI: [1.01, 1.14]). Undernourished mothers were significantly (p < 0.001) more likely to have an undernourished child. Minimum dietary diversity met for the child was protective against malnutrition; the association between WRSI and malnutrition persisted after adjustment. Conclusions. WRSI was associated with the child’s dietary diversity and malnutrition, highlighting the importance of seasonally and spatially varying local agricultural production and the relationship between growing season conditions and child nutritional status, with dietary diversity providing a potential mechanism for intervention.

Parental Childhood Feeding Experiences and Complementary Feeding Practices in Urban Households of Nigeria

ABSTRACT Background Poor complementary feeding practices can expose young children to increased burdens of undernutrition, morbidity, and poor health outcomes in adulthood. Parents and caregivers, who feed the children, are shaped by socio-cultural beliefs and pervasive socioeconomic realities. Also, parental values are influenced by their perceptions and childhood feeding experiences among others. This study, therefore, explored the role of parental childhood feeding experiences and changing socioeconomic realities on complementary feeding practices in urban households of Aba, Nigeria. Method Twenty-eight in-depth interviews and eight focus group discussions were held with parents of young children aged 6–23 months attending postnatal care clinics in selected healthcare facilities in Aba city, Nigeria. Aba city is one of the sprawling urban centers in South-East Nigeria. Data were thematically analyzed using Atlas.ti software. Results Complementary feeding practices in the Aba urban households of South-East Nigeria did not meet the recommended feeding guidelines on timely complementary feeding and dietary diversity. Consumption of processed foods and sweetened beverages was prevalent. Data suggest this feeding pattern was affected by two factors: parental feeding experiences in early life and changing socioeconomic realities. Parents who lacked satisfactory feeding experiences in their childhood but achieved some socioeconomic success in later life exhibited poor complementary feeding practices. Also, certain food types were associated with affluence notwithstanding their nutritional values. Poor complementary feeding was also linked to the parental desire to not reliving their poor childhood feeding experiences. Conclusion The parental perceived poor childhood feeding experience has led many to adopt the consumption of processed foods and sweetened beverages. This may expose children to risks of undernutrition, obesity, and overall poor health outcomes in later adulthood. More effort should be made to educate parents on healthful eating patterns and the dangers of poor complementary feeding practices in children's overall health well-being in later life.

Complementary Feeding Practices and Associated Factors in Children 6–23 months in Uttar Pradesh, India: Program Implications

Abstract Objectives Optimal complementary feeding (CF) practices among children 6–23 months can prevent childhood malnutrition and can improve long term development and health. Our study aimed to understand CF practices in children 6–23 months, as part of an ongoing nutrition program (with a focus on improving dietary diversity) in UP, India. Methods Mothers of children 6–23 months old were interviewed in 125 blocks across 25 districts of UP (N = 34,290). We assessed dietary intake using 24-hour dietary recalls and calculated minimum dietary diversity (MDD, 4 + food groups) and age-appropriate minimum meal frequency (MMF). We used multivariate logistic regression to test for associations between MDD and program exposure variables, such as frontline worker (FLW) CF knowledge, home visits by FLWs, and FLW counseling on age-appropriate CF practices, controlling for age, caste, religion, mother's education level, birth order and sex of the child. Results Merely 22% of children 6–8 months old received any semisolid/solid food the previous day, and even at 1 year of age, only 60% children received any CF. Fourteen % of all children and 5% of children 9–11 months received age-appropriate MMF. Children 6–23 months old had poor diets with only 11% reaching MDD. Only 3% of younger children (6–11 months) and 18% of children 12–23 months reached MDD. In children 12–23 months, starchy staples, pulses, other fruits and vegetables (F&amp;V) and dairy products were consumed in higher proportions (65%, 52%, 36% and 36% respectively) while Vitamin-A rich F&amp;V, eggs and flesh foods were rarely consumed (11%, 2% and 3.1% respectively). Higher odds of achieving MDD were associated with FLWs CF knowledge (OR: 3.2; 95% CI: 2.2–4.5), home visit by FLWs in the past month (OR: 1.2; 95% CI: 1.1–1.4) and counselling by FLWs on age-appropriate CF practices (OR: 1.4; 95% CI: 1.2–1.7) were positively associated with MDD. Conclusions CF practices in children 6–23 months old in these 25 districts in UP are suboptimal. Dietary diversity in this age group can be improved by improving FLW knowledge and quantity and quality of FLW interactions with families. Results suggest a need for targeted age-specific counselling to increase meal frequency and to introduce a greater variety of foods to younger children. Funding Sources Bill and Melinda Gates Foundation.

Understanding Complementary Feeding Practices in Children 6–23 Months in the West and Central Africa Region: A Mixed Methods Regional Analysis of 24 Countries

Abstract Objectives 1) To describe the trends of complementary feeding since 2010; 2) to understand the factors influencing the sub-optimal feeding practices; and 3) to generate recommendations to inform future interventions. Methods Mixed methods study with an iterative, two phase design. Phase 1: quantitative data analysis of 13 key complementary feeding indicators reported in 68 national survey reports from 2010 to 2018. Phase 2: semi-structured qualitative interviews with 14 regional informants (UN, Government, NGO, and donor communities). We conducted a literature review of grey and peer-reviewed publications in 2010–2019 to contextualize the results. Results Phase 1. Across 24 WCAR countries, mean continued breastfeeding at 1y was 89%, but halved to 44% by 2y. Introduction of complementary foods occurred in 64% of children 6–8 mos. Minimum meal frequency in children 6–23 mos increased over time from 27% to 38% while minimum dietary diversity and minimum acceptable diet were stagnant (22% and 10%, respectively) since 2010. Intake of nutrient rich foods (vitamin A, animal source, iron-rich) were reported in about half of children, respectively. The proportion of children (only reported for &amp;lt; 5 y) receiving vitamin A (66%), or iron supplements (15%), or iodized salt (79%) varied. Phase 2. Regionally, we identified policy, community, institutional, household, interpersonal, and individual level barriers. Additionally, non-modifiable factors including environmental shocks/hazards and security issues (i.e., violence), were said to disrupt food systems. From a systems perspective, major facilitators to optimal complementary feeding fell within the ‘health and nutrition’ or ‘food system’ sectors; fewer were ascribed to ‘WASH’ or ‘social protection’. Preliminary recommendations from key informants and supported by the literature review were largely multi-sectorial, yet a strong emphasis was placed on the policy level. Conclusions Since 2010, complementary feeding practices in WCAR have remained nearly unchanged. Inter-related factors influencing complementary feeding distribute across levels and sectors, suggesting the need for more multi-sectorial, integrated intervention strategies to improve child nutrition in WCAR. Funding Sources Bill &amp; Melinda Gates Foundation funding to UNICEF-WCARO.

Poor child complementary Feeding Practices in northwest Ethiopia: Finding from the Baseline Survey of Nutrition Project, 2016

BackgroundImproving infant and young child feeding practices is critical to improved nutrition, health, and development of children. Ethiopia adopted the WHO recommendations of child feeding practices and developed the national guideline. In spite of this fact, only few children start and received appropriate complementary feeding based on the recommendation. Therefore, the study aimed to determine dietary diversity score and its associated factors among under five children at Dabat Health and Demographic Surveillance System site (HDSS), northwest Ethiopia.MethodsA cross-sectional community based study was carried out from February to June 2016. All children aged 6–59 months old who lived in HDSS site were included in the survey. Odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to show the strength of association. Finally, variables with a P-value of < 0.05 were considered statistically significant..ResultsIn this study, a total of 3433 children were included. About 34.87% (95%CI: 33.27, 36.49%) of the children received adequately diversified diet. The odds of receiving adequately diversified diet was higher among children whose mother had secondary and above education (AOR = 6.51; 95%CI: 4.95, 8.56), had antenatal care (AOR = 1.90; 95%CI: 1.60, 2.26) and postnatal care visits (AOR = 1.31; 95%CI: 1.00, 1, 72), and children who feed with their family (AOR = 1.39; 95%CI: 1.17, 1.65). However, a lower dietary diversity score was observed among younger children; 6–11 months old (AOR = 0.59; 95%CI: 0.41, 0.85), and children from food insecure household (AOR = 0.76; 95%CI: 0.63, 0.92).ConclusionsDiversified diet feeding practice is low in Dabat HDSS site. Age of the child, maternal education, antenatal and postnatal care visits, and household food insecurity were significantly associated with dietary diversity of children. Hence, ensuring household food security and enhancing the coverage of maternal health care utilization are recommended to increase dietary diversity of children.

Effect of Nutrition Education on Knowledge, Complementary Feeding, and Hygiene Practices of Mothers With Moderate Acutely Malnourished Children in Uganda.

Inappropriate infant and young child complementary feeding practices related to a lack of maternal knowledge contributes to an increased risk of malnutrition, morbidity, and mortality. There is a lack of data regarding the effect of nutrition education on maternal knowledge, feeding, and hygiene practices as part of a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition in low-income countries like Uganda. To determine whether nutrition education improves knowledge, feeding, and hygiene practices of mothers with infants and young children diagnosed with moderate acute malnutrition. A cross-sequential study using a pretest-posttest design included 204 mother-infant pairs conveniently sampled across 24 randomly selected clusters. Weekly nutrition education sessions were embedded in a supplementary porridge intervention for 3 months. Mean scores and proportions for knowledge, feeding, and hygiene practices were determined at baseline and end line. The difference between mean scores at the 2 time points were calculated with the paired t test analysis, while the proportions between baseline and end line were calculated using a z test analysis. Mean scores for knowledge, dietary diversity, and meal frequency were higher at end line compared to baseline (P < .001). Handwashing did not improve significantly (P = .183), while boiling water to enhance water quality improved (P < .001). Nutrition education in conjunction with a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition improved meal frequency, dietary diversity and water quality.

Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review.

Sub-optimal nutrition among South Asian (SA) children living in high-income countries is a significant problem. High rates of obesity have been observed in this population, and differential complementary feeding practices (CFP) have been highlighted as a key influence. Our aim was to undertake a systematic review of studies assessing CFP in children under two years of age from SA communities living in high-income countries, including dietary diversity, timing, frequency and promotors/barriers. Searches covered January 1990–July 2018 using MEDLINE, EMBASE, Global Health, Web of Science, BanglaJOL, OVID Maternity and Infant Care, CINAHL, Cochrane Library, POPLINE and World Health Organisation (WHO) Global Health Library. Eligible studies were primary research on CFP in SA children aged 0–2 years. Search terms were “children”, “feeding” and “South Asian”, and derivatives. Quality appraisal used the Evidence for Policy and Practice Information (EPPI) Weight of Evidence scoring. From 50,713 studies, 13 were extracted with ten from the UK, and one each from the USA, Canada and Singapore. Sub-optimal CFP were found in all studies. All ten studies investigating timing reported complementary feeding (CF) being commenced before six months. Promoters/barriers influencing CFP included income, lack of knowledge, and incorrect advice. This is the first systematic review to evaluate CFP in SA children living in high-income countries and these findings should inform the development of effective interventions for SA infants in these settings.

Do educational interventions for caregivers improve complementary feeding practices in children ≤ 24 months?

Do educational interventions for caregivers improve complementary feeding practices in children ≤ 24 months?

Factors associated with complementary feeding practices among children aged 6-23 mo in Malawi: an analysis of the Demographic and Health Survey 2015-2016.

Optimal child complementary feeding practices are crucial for nutritional status, growth, development and health, and ultimately affect child survival. This is the first population-based study in Malawi that aimed to examine factors associated with complementary feeding practices among children aged 6-23 mo. Utilizing data from the 2015-16 Malawi Demographic and Health Survey (MDHS), 4732 children aged 6-23 mo and their mothers were analysed. The MDHS produced a nationally representative sample using a multistage cluster sampling design that included sampling weights. The impact of child, maternal, household, community and health service utilization factors on complementary feeding practices was examined using the generalized estimating equation logistic regression. After controlling for a wide range of covariates, children from mothers with secondary or post-secondary education and from mothers working in agriculture and living in the central region were significantly more likely to have timely introduction to solid, semi-solid or soft food. Surprisingly, being >1 y of age was associated with reduced odds of achieving minimum meal frequency. In addition, children >1 y of age from mothers older than 24 y and from mothers with primary, secondary and post-secondary education were significantly more likely to achieve minimum dietary diversity. Children from rich households were more likely to achieve both minimum dietary diversity and minimum acceptable diet. Finally, exposure to mass media was significantly associated with increased odds of achieving minimum meal frequency, minimum dietary diversity and minimum acceptable diet. Public health strategies aimed at reducing childhood undernutrition should focus on children from poor households whose mothers have no formal education and are unemployed. In addition, exposure to mass media had a positive impact on the three complementary feeding indicators. Therefore behaviour change communication messages through mass media aimed at promoting child nutrition are necessary to achieve optimal child complementary feeding practices.

Complementary feeding practices of children (6 months-23 months) in and around Lucknow, India

Background: According to infant and child mortality in India, levels trends and determinants the under 5 mortality rates (UFMR) of India is facing a steady decline but at this rate India could not meet its target of millennium development goal-4 (MDG-4), which aimed to reduced UFMR by 2/3rds between 1990 and 2015. Objective of the current study was to study the complementary feeding practices amongst children of age group 6 months to 23 months in Lucknow.Methods: In this prospective cross sectional study 256 mothers were interviewed over a period of 6 months at a referral care centre in Lucknow. Children of age groups 6-8 months, 9-11 months and 12-23 months attending the Paediatric OPD were included in the study. WHO anthropometric indices of nutritional status: weight-for-age, length-for-age and weight-for-length, expressed in standard deviation (SD) units (z-scores) were calculated. Information on feeding practices and various particulars of the study children were taken into account and the WHO Indicators for assessing infant and young child feeding practices were calculated. Complementary feeding index CFI was calculated using these WHO indicators.Results: In the study group 24% of the children were stunted, 38% were underweight and 35% were wasted. The CFI was seen to be low in 32%, medium in 61% and high only in 7% children. It was found that parental education had significant correlation with CFI. Weight for height was significantly associated with CFI (p=0.011).Conclusions: CFI is an important tool to target the lacunae in complementary feeding practices. The CFI scores directly correlate with the nutrition status of children thus targeting the determinants of CFI will bring a positive change in infant and young child feeding practices.

Systematic review of infant and young child complementary feeding practices in South Asian families: the India perspective.

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 India. 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' and derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence). From 45 712 abstracts screened, sixty-four cross-sectional, seven cohort, one qualitative and one case-control studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF practices were found in all studies. In twenty-nine of fifty-nine studies, CF was introduced between 6 and 9 months, with eight studies finding minimum dietary diversity was achieved in 6-33 %, and ten of seventeen studies noting minimum meal frequency in only 25-50 % of the study populations. Influencing factors included cultural influences, poor knowledge on appropriate CF practices and parental educational status. This is the first systematic review to evaluate CF practices in SA in India. Campaigns to change health and nutrition behaviour and revision of nationwide child health nutrition programmes are needed to meet the substantial unmet needs of these children.

Systematic review of infant and young child complementary feeding practices in South Asian families: the Pakistan perspective.

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.

Complementary Feeding Practices of Children Aged 6-23 Months in Rural Area, Southern-Benin: Challenges and Opportunities

Complementary Feeding Practices of Children Aged 6-23 Months in Rural Area, Southern-Benin: Challenges and Opportunities

Assessment of Salient Beliefs Affecting Mothers' Intention to Adherence to Dietary Diversity in their Children's Complementary Feeding.

Background:Providing a variety of foods has been emphasized as one of the most important features of optimal complementary feeding. This study investigated key beliefs that guide mothers’ intention to adherence to dietary diversity in their 1–2-year-old children's complementary feeding.Methods:This was a cross-sectional study involving 290 mothers (mean age = 27, standard deviation = 5.32) with child 1–2-year-old attending maternal and child health section of health centers in Rasht, Iran. To represent the socioeconomic status of the participants, 6 centers out of 15 were selected from three different socioeconomic areas (low-, middle-, and high-income areas). Mothers completed a questionnaire assessing intention and belief-based items of theory of planned behavior. Correlations and multiple regression analyses were performed.Results:The mean age of mothers was 27 ± 5.33 (27–43 years). Regression analyses revealed that among behavioral beliefs, the perception that adherence to dietary diversity would lead to improve children's growth was the significant predictor of intention (β = 0.13, P = 0.04). Regarding normative beliefs, perceived social pressure from health-care professionals to adherence to dietary diversity significantly predicted intention (β = 0.15, P = 0.01). Among control beliefs, the perception that daily pressures made difficult adherence to dietary diversity was the key determinant (β = 0.19, P = 0.01).Conclusions:Findings of this study represent the important beliefs that can be addressed in development planning aimed at modifying mothers’ child complementary feeding practices.

Measuring Infant and Young Child Complementary Feeding Practices: Indicators, Current Practice, and Research Gaps.

The publication of the WHO Infant and Young Child Feeding (IYCF) indicators in 2008 equipped the nutrition and broader development community with an invaluable tool for measuring, documenting, and advocating for faster progress in improving these practices in low- and middle-income countries (LMICs). The indicators, with 5 of them focusing on complementary feeding (CF) practices, were originally designed for population level assessment, targeting, monitoring, and evaluation. This chapter takes stock of where we are with the existing CF indicators: it reviews how the indicators have been used, what we have learned, and what their strengths and limitations are, and it suggests a way forward. We find that the indicators have been used extensively for population level assessments and country comparisons, and to track progress. They have also been adopted by researchers in program impact evaluations and in research seeking to understand the determinants and consequences of poor CF practices for child growth and development outcomes. In addition to generating a wealth of knowledge and unveiling the severity of the global problem of poor CF practices in LMICs, the indicators have been an invaluable tool to raise awareness and call for urgent action on improving CF practices at scale. The indicators have strengths and limitations, which are summarized in this chapter. Although enormous progress has been achieved since the indicators were released in 2008, we feel it is time to reflect and revisit the CF indicators, improve them, develop new ones, and promote their appropriate use. Better indicators are critically important to stimulate action and investments in improving CF practices at scale.

Breastfeeding patterns and its determinants among mothers living with Human Immuno-deficiency Virus -1 in four African countries participating in the ANRS 12174 trial.

BackgroundHIV-1 transmission rates have been reduced over the last decade, an estimated 2 million new infections per year arise, including 220,000 paediatric cases. The main post-natal HIV exposure is through breastfeeding, where both its duration and modality (exclusive or not) are associated with postnatal transmission. The ANRS 12174 trial compared HIV-1 postnatal transmission of 2 prophylaxis drugs for infants during lactation (lamivudine and lopinavir-ritonavir). Our objective has been to examine the feeding practices and the determinants of exclusive/ predominant (EPBF) or any breastfeeding among the participants of this trial in Burkina Faso, South Africa, Uganda and Zambia.MethodsMothers infected with HIV-1 and their uninfected offspring were followed from day 7 after birth for 50 weeks, keeping monthly records of their feeding patterns. Feeding was classified into 3 categories: 1) exclusive breastfeeding during the first six months, only breast-milk being given to infant for 6 months, 2) predominant breastfeeding, breast-milk with liquid-based items being given, and 3) mixed feeding, other non-breast milk or solid food being given in addition to breast milk with or without liquid-based items. The categories were merged into 2 groups: EPBF applying to infants aged <6 months and mixed feeding applying to infants of any age. The feeding patterns have been given as Kaplan-Meier curves. A flexible parametric multiple regression model was used to identify the determinants of the mothers’ feeding behaviour.ResultsA total of 1,225 mother-infant pairs provided feeding data from Burkina Faso (N = 204), South Africa (N = 213), Uganda (N = 274) and Zambia (N = 534) between November 2009 and March 2013. The mean maternal age was 27.4 years and the mean BMI was 24.5. 57.7 and 93.9% of mothers initiated breastfeeding within the first hour and first day, respectively. Overall, the median durations of any form of breastfeeding and EPBF were 40.6, and 20.9 weeks, respectively. Babies randomized to the lopinavir/ritonavir group in South Africa tended to do less EPBF than those in the lamivudine group.Overall the group of mothers aged between 25 and 30 years, those married, employed or multiparous tended to stop early EPBF. Mothers living in Uganda or Zambia, those aged between 25 -30 years, better educated (at least secondary school level), employed or having undergone C-section stopped any breastfeeding early.ConclusionsThere is a need to improve breastfeeding and complementary feeding practices of children, particularly those exposed to HIV and anti-retrovirals, taking into account context and socio-demographic factors.Trial registrationClinical trial registration: NCT00640263.Electronic supplementary materialThe online version of this article (doi:10.1186/s13006-017-0112-2) contains supplementary material, which is available to authorized users.