Determinants Of Complementary Feeding Practices Research Articles

Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review.

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children's health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics.

Determinants of complementary feeding practices among children aged 6–24 months in urban slums of Pune, Maharashtra, in India

BackgroundInequalities in child feeding practices are evident in urban slums in developing nations. Our study identified the determinants of complementary feeding (CF) practices in the informal settings of Pune, India, a district close to the business capital of India.MethodsEmploying a cross-sectional study design, 1066 mother–children dyads were surveyed. Five indicators defined by the WHO were used to study complementary feeding practices. Determinants of complementary feeding practices were identified using multivariate analyses.ResultsTimely initiation of CF was reported by 42%. Minimum acceptable diet (MAD), minimum meal frequency (MMF), and Diet Diversity Score > 4 were achieved by 14.9%, 76.5%, and 16.4%, respectively. Continued breastfeeding (CBF) at 2 years, and feeding processed foods were practiced by 94% and 50%, respectively. Among the maternal characteristics, a mother’s age > 30 years at pregnancy was less likely to achieve DD [AOR: 0.195 (CI 0.047–0.809)] and MAD [AOR: 0.231 (CI 0.056–0.960)]. Mothers with lower education were less likely to meet MMF [AOR: 0.302 (0.113–0.807)], MAD [AOR: 0.505 (CI 0.295–0.867)] and to introduce formula feeds (FF) [AOR: 0.417 (0.193- 0.899)]. Among obstetric characteristics, birth spacing < 33 months was less likely to achieve DD [AOR: 0.594 (CI 0.365–0.965)] and CBF [AOR: 0.562 (CI: 0.322–0.982)]. Receiving IYCF counseling only during postnatal care hindered the timely initiation of CF [AOR: 0.638 (0.415–0.981)]. Very Low Birth Weight increased the odds of achieving DD [AOR: 2.384 (1.007–5.644)] and MAD [AOR: 2.588(CI: 1.054–6.352)], while low birth weight increased the odds of children being introduced to processed foods [AOR: 1.370 (CI: 1.056–1.776)]. Concerning socio-economic status, being above the poverty line increased the odds of achieving MMF, [AOR: 1.851 (1.005–3.407)]. Other backward castes showed higher odds of achieving MAD [AOR: 2.191 (1.208–3.973)] and undisclosed caste in our study setting decreased the odds of FF [AOR: 0.339 (0.170–0.677)]. Bottle feeding interfered with MMF [AOR: 0.440 (0.317–0.611)] and CBF [AOR: 0.153 (0.105–0.224)].ConclusionInvesting in maternal education and IYCF counseling during both ANC and PNC to provide nutritious complementary foods alongside addressing poverty should be a national priority to prevent the double burden of undernutrition at an early age in informal settings.

Determinants of Complementary Feeding Practices and Nutritional Status of Children 6 – 23 Months in Pastoralist Communities of Isiolo, Kenya

Optimal complementary feeding practices play a vital role in the nutritional status of young children. In Kenya, significantly higher rates of acute malnutrition have been reported among pastoralist communities, particularly among children aged 6-23months. There is inadequate complementary feeding data on pastoralist communities despite their vulnerability. The objective of the study was to establish the determinants of complementary feeding practices and nutritional status of children 6-23 months among pastoralist communities of Isiolo County, Kenya. A cross-sectional analytical study using two-stage cluster sampling methodology was applied to select a sample of 288 children aged 6-23 months from pastoralist communities. Data on the socio-demographic characteristics of the study population, complementary feeding practices and anthropometric measurements of the children aged 6-23 months was collected and analysed. Overall, the prevalence of stunting, underweight and wasting was 19.1%, 7.3% and 5.2% respectively. A variation in malnutrition prevalence was observed with age of children, with the 18-23month age group showing a higher prevalence of all forms of undernutrition. Male children had significantly higher proportions of underweight and stunting (p ≤ 0.05). Complementary feeding practices were sub-optimal - minimum meal frequency (60.4%), minimum dietary diversity (35.4%) and minimum acceptable diet (25.3%). Child age, child sex, caregiver’s age, and caregiver education level were significant determinants for complementary feeding practices and nutritional status of children 6-23months (p ≤ 0.05). We recommend that community based approaches targeting pastoralist communities should address the basic cause of child malnutrition through nutrition education and women empowerment initiatives.

150Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016

Abstract Background Introducing appropriate complementary feeding at sixth months of age is crucial for the optimal growth and development of an infant. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016. Methods The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2520), 2011 (N = 2850), and 2016 (N = 2864). Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service and community-level factors and (i) the introduction of complementary foods, (ii) minimum dietary diversity (MDD), (iii) minimum meal frequency (MMF) and (iv) minimum acceptable diet (MAD). Results The proportion of mothers who met MDD increased from 6.3% to 13.5% and MAD increased from 4.1% to 7.1% from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%), and MMF (from 41.3% to 43.6%) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD. Conclusions Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage and media exposure Key messages The study showed that there were improvements in the proportion MDD and MAD.

Determinants of appropriate complementary feeding practices among women with children aged 6-23 months in Iseyin, Nigeria

Malnutrition and poor complementary feeding are more predominant in rural than urban areas. Yet, little attention has been given to these discrepancies and the use of validated composite index to explore determinants of complementary feeding practices. Hence, this study was aimed at identifying the determinants of appropriate complementary feeding practices among mothers with children aged 6-23 months in Iseyin, Nigeria.A community based cross sectional survey involving 390 mother-child dyads was conducted using a three-stage simple random sampling. Information on household sociodemographic characteristics, complementary feeding practices, 24-hour dietary intake and anthropometric characteristics of youngest child in the household were obtained using a semi-structured questionnaire. Complementary feeding indicators and anthropometric indices were estimated using the 2008 World Health Organization recommendations and WHO Anthro, respectively. Data were analysed using descriptive statistics and logistic regression at p<0.05.Mothers’ mean age was 28.7± 5.6 years, 99.4% were married, and 92.1% attended antenatal care sessions. Mean age of children was 14.5±5.1 months, 56.2% were male and 31.0% were firstborn. Of all the children, 72.3% had timely introduction of complementary food, 17.7% had minimum dietary diversity, 46.9% had minimum meal frequency and 14.9% had minimum acceptable diet. Grains, root and tubers (91.3%) constituted the mostly consumed complementary foods. Overall, only 10.0% of children had appropriate complementary feeding; child's age, birth order and mother's income were determinants of appropriate complementary feeding.Appropriate complementary feeding practices remain very low and this is influenced by the child's age, birth order and mother's income.

Complementary feeding practices and associated factors among children aged 6-23 months in Pakistan.

Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey (2017–18). The results show that only 12% of children consume a minimum acceptable diet, 21% achieve minimum dietary diversity, and 38% reach minimum meal frequency. Multivariate regression analysis shows that child age, child weight at birth, mother’s access to newspapers/magazines at the individual level, wealth at the household level, and prenatal visits at the community level are significant predictors of complementary feeding practices among children aged 6–23 months in Pakistan. These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan. This consequently reduces premature mortality and undernutrition.

Trends and factors associated with complementary feeding practices in Ethiopia from 2005 to 2016.

Introducing appropriate complementary feeding at 6 months of age is crucial for the optimal growth and development of an infant. In Ethiopia, however, no previous national‐level studies have examined the trends and associated factors of complementary feeding practices. The aim of this study is to investigate the trends and determinants of complementary feeding practices in Ethiopia from 2005 to 2016. The study was conducted using the Ethiopia Demographic and Health Survey (EDHS) data for 2005 (N = 2,520), 2011 (N = 2,850), and 2016 (N = 2,864). Percentage point changes in complementary feeding indicators were estimated to examine the trends over the EDHS years. Multivariate logistic regression was used to examine the association between socioeconomic, demographic, health service, and community‐level factors and (a) the introduction of complementary foods, (b) minimum dietary diversity (MDD), (c) minimum meal frequency (MMF), and (d) minimum acceptable diet (MAD). The proportion of mothers who met MDD increased from 6.3% to 13.5% (p < .001), and MAD increased from 4.1% to 7.1% (p = .003) from 2005 to 2016. Improvements in the introduction of complementary foods (from 50.3% to 59.5%, p = .051) and MMF (from 41.3% to 43.6%, p = .288) were not statistically significant. Maternal education and occupation were associated with the introduction of complementary foods, MDD, MMF, and MAD. Higher partner education and frequent antenatal visits were associated with MDD and MAD. Children whose mothers listened to the radio had higher odds of MDD, MMF, and MAD. Our analysis of the EDHS suggests that the proportion of MDD and MAD were unacceptably low. Interventions aiming to improve complementary feeding practices in Ethiopia should also target mothers with low education, antenatal service usage, and media exposure.

Trends and determinants of complementary feeding practices in Tanzania, 2004\u20132016

BackgroundFollowing the successful implementation of the Millennium Development Goals (MDGs) strategy in Tanzania, improvements in child health indicators were observed. However, it remains unclear whether complementary feeding practices have improved given the renewed global agenda on child nutrition. This study investigated trends and socioeconomic and health service factors of complementary feeding practices in Tanzania for the period spanning from 2004 to2016.MethodsThe study was based on the Tanzania Demographic and Health Survey data for the years 2004–2005 (n = 2480), 2010 (n = 2275) and 2015–2016 (n = 2949) to estimate the trends in complementary feeding practices. Multivariate logistic regression models that adjusted for year of the survey, clustering and sampling weights were used to investigate the association between the modifiable study factors (socioeconomic and health service factors) and complementary feeding practices among children aged 6–23 months in Tanzania.ResultsOver the study period, minimum dietary diversity (MDD) and minimum acceptable diet (MAD) have worsened from 46% (95% confidence interval [95% CI] 41.5–50.7%) in 2004–2005 to 30% (95% CI 25.7–32.9%) in 2015–2016 and 16.9% (95% CI 14.9–18.9%) in 2004–2005 to 6.0% (95% CI 4.9–7.1%) in 2015–2016, respectively. Minimum meal frequency (MMF) remained unchanged, 37% in 2004–2005 and 2015–2016. The introduction of solid, semi-solid and soft foods improved from 79% (95% CI 74.5–83.9%) in 2004–2005 to 87% (95% CI 83.7–90.9%) in 2015–2016. Multivariate analyses revealed that higher maternal education and household wealth, mother’s employment, health facility birthing and postnatal care (PNC) visit were associated with MDD, MAD and MMF. Traditional birth attendant-assisted births and PNC visits were associated with the introduction of complementary foods. In contrast, birthing in the health facility was associated with the delayed introduction of complementary foods.ConclusionBetween 2004 and 2016, the prevalence and determinants of complementary feeding practices varied in Tanzania. Improving complementary feeding practices is feasible in Tanzania given the renewed focus on child nutrition in the country. Child nutrition policy interventions should target all mothers, particularly mothers from low socioeconomic background and those with limited access to health services to maximise results.

Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6\u201323\xa0months in Southern Benin

Poor complementary feeding practices have detrimental effects on child growth, development and survival. This cross-sectional study in rural areas of southern Benin examined some determinants of complementary feeding practices using socioeconomic and dietary data collected among 1225 primary caregivers. Determinants of complementary feeding practices in the study areas are multidimensional and include many interacting factors such as socio-economic aspects, farming practices, household demographics, cultural practices and geography. Child age, diversity of food groups produced, income allocated to feeding, commune of residence, ethnicity, caregivers’ occupation, marital status and household size were identified as the main factors affecting complementary feeding practices. Food group diversification in farm-systems and overall social behavior and support as well as women’s empowerment are necessary to improve children’s diets. Reducing women’s workload through improved working conditions appears crucial to decrease time burdens and allow more time for child care. Multisectoral interventions should be embraced to improve complementary feeding practices in Benin.

Determinants of Complementary Feeding Practices among Children Aged 6-23: a Community based Study

BackgroundComplementary feeding practices play an important role in growth and development of the children. This study aimed to determine the complementary feeding practices status among children aged 6- 23 months and its association with various socio- demographic factors.Materials and MethodsThis community based cross-sectional study was conducted at field practice area of Urban Health Centers in Khalkhal city, North West of Iran. In the preset study 576 mothers of children aged 6-23 months were selected with multistage random sampling method and interviewed using structured questionnaire for Infant and Young Child Feeding (IYCF) indicators (minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Data were analyzed with using SPSS-20.0, Chi-square, bivariate and multivariate logistic regression tests.ResultsFindings showed that MDD, MMF and MAD were adequate in 42.3%, 42.7% and 30.9%, respectively. MDD and MAD was significantly associated with gender of child, type of delivery, birth order of child, mothers literacy and health literacy (P<0.001); MMF was significantly associated with health literacy and literacy status of mother, birth order of child (P<0.001).ConclusionThe study revealed that majority of mothers practiced inadequate complementary feeding. The feeding practices were found to be significantly associated with various socio- demographic factors which highlighted the importance of addressing these factors for improvement of feeding practices and prevention of various health related problems among children.

Association of Frontline Worker-Provided Services with Change in Block-Level Complementary Feeding Indicators: An Ecological Analysis from Bihar, India.

BackgroundInsufficiencies in complementary feeding put infants and young children at increased risk of undernutrition. Till now, most Indian studies have looked at the individual level determinants of complementary feeding practices. We aimed to evaluate the association of frontline worker (FLW) provided nutritional counselling services, with change in community level indicators of complementary feeding practices among 9–11 month old children over time.MethodsThe study data was obtained from five rounds of ‘Lot Quality Assurance Sampling’ survey in eight districts of Bihar, an impoverished Indian state. The surveys were conducted as evaluation exercises for the ‘Integrated Family Health Initiative (IFHI)’–a multi-faceted program aimed at improving the maternal and child health outcomes in Bihar. The main outcome indicators were—current breastfeeding, age-appropriate minimum frequency of semi-solid food, age-appropriate minimum quantity of semi-solid food, initiation of complementary feeding at the right age, and dietary diversity. Repeated measures analysis was performed to determine the association of changes in the outcome indicators with coverage of FLW-provided counselling services.ResultsVisits by FLW, advices on age-appropriate frequency and handwashing were significant predictors of receiving age-appropriate frequency of feeding. The determinants of receiving age-appropriate quantity were—advices on age appropriate frequency and advices on handwashing. Receiving food support from AWC and FLW visits were significantly associated with initiating complementary feeding at the right age.ConclusionsThe present study identified the critical elements among the different types of FLW-provided services. The study findings, from an economically and socially underdeveloped region of India, would inform the relevant programs about the nutritional counselling services that need to be emphasized upon for reducing the burden of childhood malnutrition.

Determinants of complementary feeding practices among mothers of 6-24 months failure to thrive children based on behavioral analysis phase of PRECEDE model, Tehran.

Background:This study intended to clarify the determining factors of complementary feeding practices among Tehran 6–24 months failure to thrive children in order to use the results for planning the interventions to reduce the possible adverse effects.Materials and Methods:In this study, 132 mothers of three medical and health centers were chosen by random sampling among those centers operating under the supervision of south of Tehran District Health Center and study data were collected from them. A valid and reliable questionnaire as a data collection instrument developed based on behavioral analysis phase of PRECEDE model. Spearman and Pearson's correlation coefficient test were used to determine the statistical relationship between factors associated with complementary feeding practices among mothers.Results:The mothers’ knowledge was as follows: 0.8%, 20.4%, and 78.8% of them were good, medium, and poor, respectively. Mean scores for the mothers’ performance in terms of supplementary feeding was 66.8. Pearson correlation indicated a positive and significant correlation between the mothers’ performance with enabling and reinforcing factors, but there wasn’t any significant relationship between the mothers’ performance and knowledge about complementary feeding.Conclusions:According to the obtained results, reinforcing factors, and enabling factors are associated with the mothers’ performance in terms of complementary feeding. Hence, attention to these issues is essential for better health interventions planning.

Determinants of complementary feeding practices among Nepalese children aged 6–23 months: findings from demographic and health survey 2011

BackgroundThe adoption of inappropriate feeding practices is one of the reasons for under nutrition in Nepal and elsewhere. The objective of this study was to describe the rate of and identify the factors associated with providing the World Health Organization (WHO) recommended infant feeding practices of minimum dietary diversity, minimum meal frequency and minimum acceptable diet in Nepal amongst young children between 6–23 months in 2011.MethodsData from Nepal Demographic and Health Survey (NDHS) 2011 was used. Prevalence of minimum dietary diversity, minimum meal frequency and minimum acceptable diet was obtained by using descriptive statistics. A Chi-square test (χ2) followed by multiple logistic regression analyses were used to determine the adjusted effect of potential factors on the outcome variables.ResultsOf the 698 children aged 6–23 months; while 535 (76.6%) received the minimum meal frequency, only 212 (30.4%) children received the minimum dietary diversity, and 185 (26.5%) received an acceptable diet. Children of older mothers (>35 years); educated mothers and fathers; and mothers from all the development regions except the Mid-western region were more likely to have been provided with the recommended dietary diversity. Children of mothers who had attended ≥4 antenatal visits and who lived in the Eastern region were more likely to provide their child with the recommended meal frequency. Children of mothers, who attended ≥ 4 antenatal visits, were educated and whose fathers had at least a secondary education were more likely to meet the recommended acceptable diet standards.ConclusionYoung children aged less than two years in Nepal are at risk for not meeting the WHO recommended infant feeding standards given that only about one in three children were provided with the recommended dietary diversity and acceptable diet. This finding suggests that the majority of children are at risk of under nutrition. An appropriate mix of health education and food supplements could be a feasible option for Nepal to improve the number of children who meet the recommended infant feeding guidelines, reduce under nutrition and improve the survival rates of young children.