Inappropriate Complementary Feeding Practices Research Articles

Inappropriate complementary feeding practice increases risk of stunting in children aged 12-24 months

Background<br />In 2013, the prevalence of stunting in Central Sulawesi province was 41%, which was higher than the national prevalence of 37.2%. Complementary feeding practice, infectious disease, history of exclusive breastfeeding, birth weight and birth length were assumed to contribute to the prevalence of stunting. The objective of the present study was to identify the risk factors for stunting among children aged 12 to 24 months.<br /><br />Methods<br />This study was conducted using a case control design. Subjects were children aged 12-24 months, consisting of 58 cases and 58 controls. Data were obtained with a body length infantometer. Data on complementary feeding practices, history of exclusive breastfeeding, and history of infectious diseases were obtained using questionnaires. Nutrient intakes were measured by semi quantitative food frequency questionnaires. Data on birth weight and birth length were obtained from the buku KIA (maternal and child health record). Data were analyzed by chi-square and logistic regression tests. <br /><br />Results<br />There was no difference in sex, BMI, and parental education between cases and controls (p>0.05). After controlling for history of exclusive breastfeeding and birth weight, the risk factors for stunting were inappropriate complementary feeding practice in terms of quantity and quality (OR=8.26; 95% CI: 2.69-25.44), history of diarrhea (OR=4.73; 95% CI: 1.08-20.69), birth length (OR=5.11; 95% CI: 1.69-15.46) and respiratory tract infection (OR=5.30; 95% CI: 1.03-27.23). Inappropriate complementary feeding practice was the most dominant factor for stunting.<br /><br />Conclusion<br />Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.

Complementary feeding practices among mothers and nutritional status of infants in Akpabuyo Area, Cross River State Nigeria.

Background Malnutrition in infants during weaning has been attributed to inappropriate complementary feeding practices and it underlies more than one-third of child mortality in Nigeria. Thus, addressing the influence of complementary feeding practice on nutritional status may be an important approach to reducing the burden of child malnutrition. This cross-sectional study investigated the association between complementary feeding practices among mothers and nutritional status of their infants in Akpabuyo Local Government Area, Nigeria. The study enrolled 330 mother–child pairs from 10 randomly selected out of 32 Health Facilities in Akpabuyo. Socio-demographic information, child and maternal characteristics were obtained using an interviewer-administered questionnaire. Complementary feeding practices were assessed with World Health Organization infant and young child feeding indicators. Nutritional indicators wasting, underweight and stunting were determined.ResultsPrevalence of timely introduction of complementary feeding among infants aged 6–8 months was 85.4%, minimum dietary diversity rate was 31.5%, and minimum meal frequency 36.7%, the rate of minimum acceptable diet was 7.3%. One-third (33.3%) of the infants were underweight, 26.4%, wasted and 24.6%, stunted. Children who did not receive timely complementary foods had higher odds for wasting (OR 5.15; 95% CI 1.50–17.73). Children who did not receive the minimum dietary diversity had higher odds for underweight than children who received the minimum dietary diversity (OR 2.07; 95% CI 1.17–3.70). Children who did not receive the minimum feeding frequency were more likely to be stunted than their peers who received the minimum feeding frequency (OR 1.57; 95% CI 1.53–4.03).ConclusionSub-optimal complementary feeding predisposed to infant’s malnutrition.

Imperatives for reducing child stunting in Bangladesh.

Although there has been a decline in rates of child stunting in Bangladesh, more than one‐third of under‐five children still suffer from impaired linear growth. Results of the demographic health surveys since 2004 show that the rate of stunting decreased by only 1.5 percentage points per year (NIPORT, Mitra and Associates & ICF International, 2015). This is not anticipated, given the impressive results the country has demonstrated in reducing infant and maternal mortality over the past two decades (NIPORT, MEASURE Evaluation, and ICDDR,B 2012). Stunting seems to be pervasive throughout the country and is very high in children in slum settlements. Poverty and lack of education are associated with stunting in Bangladesh as elsewhere; however, 21% children from households belonging to the richest wealth quintiles are also stunted. About one‐third of children of literate mothers also suffer from stunting. Therefore, the aetiology of stunting is still not clear, although data from Bangladesh suggest that factors associated with the condition include poor maternal nutrition, low birthweight (LBW), severe food insecurity, inappropriate complementary feeding, poverty, illiteracy, poor sanitation, and hygiene practices (Ahmed et al, 2012; Psaki et al., 2014). There is increasing evidence that environmental enteropathy, a condition where the small intestinal mucosa is colonized and damaged by pathogenic bacteria, is one cause of malabsorption of nutrients and stunting. This happens when hygiene and sanitation practices are poor and young children are chronically exposed to bacteria in the environment.

Complementary Feeding Practices of Mothers and Their Perceived Impacts on Young Children: Findings from KEEA District of Ghana.

Objective Appropriate and timely complementary feeding practices are fundamental to a child's growth, health, and development during the first 2years of life. This study aimed to understand (1) Ghanaian mother's complementary feeding practices, and (2) their perceived and observed impacts of complementary feeding on their children. Methods Ghanaian mothers with children 4-24months of age were recruited from four communities in the Komenda Edina Eguafo Abrem district in the Central Region of Ghana (n=99). A qualitative methodological approach with focus group interview discussions was used. Eleven focus group interviews were conducted, and were audio recorded and transcribed. The audio transcriptions were coded and analyzed into pertinent themes, meta-themes, and theoretical concepts. Results Over 80% (85) of mothers reported poor knowledge about the effects of complementary feeding on their children and 45% (45) of the children were undernourished, indicating inappropriate complementary feeding practices. Some mothers held misconceptions about the effect of food on children's health. Four overarching themes were identified: (1) mothers' background knowledge about food, child health and growth outcomes, (2) mothers' motivation in feeding their children, (3) barriers to feeding, (4) foods mothers offered their children. Conclusion for Practice Nutrition education on complementary feeding is needed for Ghanaian mothers. Health facilities and community outreach programs could be a venue to provide education to mothers regarding infant and young child feeding practices in Ghana.

Maternal knowledge and attitudes in relation to complementary feeding initiation in rural Bangladesh

Inappropriate complementary feeding (CF) practices are common in Bangladesh. To identify predictors of the timing of introduction of solid/semi‐solid/soft foods (CF initiation) in rural Bangladesh, we prospectively interviewed 2073 pregnant women at 28 weeks' pregnancy and at postnatal months 3 and 9. We assessed CF knowledge and attitudes at the 3 mo visit. CF initiation was characterized as early (蠄4 mo), timely (5‐6 mo) or late (蠅7 mo), based on maternal recall at the 9 mo visit. We used polytomous logistic regression, adjusted for SES, infant gender, maternal age, literacy and parity. Timely CF initiation was referent.
 CF initiation was early for 7%, timely for 49%, and late for 44% of infants. Only 19% of mothers knew the recommended CF initiation age. Knowledge and attitudes tertiles were 0 – 7, 8 – 9, and 10 – 15, and 19 – 29, 30, and 31 – 39, respectively. Mothers with the lowest knowledge tertile were more likely to initiate early CF compared to those with the highest tertile (aOR = 0.6, 95% CI: 0.3 – 0.9). Mothers with the highest attitudes tertile were more likely to initiate late CF compared to those with the lowest tertile (aOR = 1.3, 95% CI: 1.0 – 1.6). Multiparous mothers were significantly less likely to initiate timely CF compared to those with 1 child (early vs. timely aOR = 1.9; 95% CI: 1.2, 3.1; late vs. timely aOR = 1.3, 95% CI: 1.0, 1.7). SES, infant gender, maternal age and literacy were not associated with age at CF initiation.
 Efforts discouraging early CF initiation have been successful but late introduction of foods is still widely prevalent in Bangladesh. Interventions to improve infant nutrition need to promote timely CF initiation.

Ghanaian Mothers' Complementary Feeding Practices and Perception on Children's Health

Objectives: To understand factors that influence Ghanaian mothers' introduction and variety of complementary foods, and capture their perception of the implications of complementary foods on children's health, growth, and development.Methods: Ghanaian mothers (n=99) with children 4‐24 months of age from the Central Region of Ghana were recruited to participate. Eleven focus groups interviews were conducted and a participant demographic questionnaire was administered. A focus group guide was developed to ask mothers' opinions about their complementary feeding practices. Sessions were audio recorded, and transcribed. The transcriptions were coded and analyzed to identify themes, meta‐themes, and to generate theories.Results: Participants reported inappropriate complementary feeding practices: early introduction of solids, early cessation of breastfeeding, inappropriate cues of introducing solids, and inadequate frequency of offering complementary foods. Mothers stated factors that influenced complementary feeding: finances, time, moms' food preference, convenience, and beliefs. Finance was the major determinant to the food offered to their children, irrespective of the implication. Mothers' knowledge about food, child health, and growth outcomes motivated their feeding practices. However, motivation was affected by the lack of support from spouse, picky eating habits of children, and finances. While over 80% (85) of the moms reported some knowledge about the effects of complementary feeding, 45% (45) of the children were undernourished. Some mothers held misconceptions about the effect of food on children's health.Implications: Ghanaian mothers identified challenges and misconceptions in complementary feeding, indicating the need for nutrition education and support.

Complementary feeding practices and nutritional status of children 6-23 months in Kitui County, Kenya

Objectives : Inappropriate complementary feeding practices among children aged 6-23 months is major cause of under nutrition. There is scarce information on the relationship between complementary feeding practices and nutritional status. This study aimed to determine the factors contributing to the complementary feeding practices and the nutritional status of children aged 6 -23 months. Methodology and Results : A randomly selected sample of 201 children aged 6-23 months was investigated using a cross sectional analytical design in four randomly selected sub-counties in Kitui County. Data were analyzed using ENA for SMART for nutrition status, Nutri-survey for dietary intake and SPSS. Results showed that most caregivers (70.6%) had attained primary level education. Majority of respondents (69.2%) had low levels of income. The average number of meals consumed per day was 4.1 ± 0.01. The main foods consumed were carbohydrates with little consumption of fruits and vegetables. The levels of wasting, stunting and underweight were 7.0%, 22.9% and 10.9%, respectively. Conclusions and application of findings : The complementary feeding practices were inadequate to meet the macronutrient and micronutrients needs of the children. The foods lacked variety, children took fewer meals per day and key foods were consumed less frequently than expected. The low food production in the semi- arid area coupled with low income could be associated with the food insecurity and consequently to the quality, quantity and diversity of the foods consumed by the children. The levels of malnutrition were relatively high for these children aged 6-23 months and this could be attributed to food insecurity indicated by low dietary diversity. The study noted a significant relationship between complementary feeding practices and nutritional status. The study recommends use of locally available, affordable and variety of foods to improve nutrient content of complementary foods. The study recommends agricultural interventions to enhance the nutritional content of complementary foods. Nutrition education on appropriate Infant and Young Child Feeding among mothers is essential. Key words : Complementary feeding practices, Nutritional status, children under 6-23 months

Study of Complementary Feeding Practices and Some Related Factors among Mothers Attending Primary Health Centers in Sari, Iran, in 2013

Background and purpose: Inappropriate complementary feeding practices are one of the causes of malnutrition worldwide. This study was aimed to determine the complementary feeding practices according to World Health Organization recommendation in Sari, Iran. Materials and Methods: This cross-sectional study on complementary feeding practices assayed the different aspect of infant feeding based on maternal, childbirth, and infant characteristics. This study was conducted during the period between March and June 2013 on 401 mothers of infants under 1 year of age attending primary health centers using Poisson random sampling method and semi-structured questionnaire. A chi-square test was used to analyze the data. Results: Almost 83.6% of mothers started complementary feeding at recommended age of 6 months. The most common starting food was Fereni (51.5%). About half of mothers fed their infants complementary food of appropriate consistency (49%) with recommended frequency (54.6%). Fathers’ educational level was found to be the significant associated factor with appropriate complementary feeding practices (P = 0.02). Conclusion: Complementary feeding practices by mothers in the capital city of Mazandaran province are still inappropriate in term of consistency, frequency and type of food introduced. Emphasis should be given to educating mothers and fathers about this important issue.

Magnitude and Determinants of Stunting Among Children in Africa: A Systematic Review

Globally it is estimated that 162 million under-five year old children are stunted. Africa is known with one of the highest prevalence of stunting in the world. Even though studies suggested various determinants for stunting in Africa; there is lack of agreement about the relative importance of factors affecting the nutritional status of children. We reviewed all literatures, including: observational studies, and prospective randomized controlled trials (RCTs) evaluating the prevalence and determinants of stunting in children under the age of five years in Africa to identify systematically, appraise and synthesize the best available evidence on the magnitude and epidemiological factors for stunting among children under the age of five years in Africa by conducting electronic search of Medline, Pub Med, Health Inter-network access to Research Initiative (HINARI), and Google Scholar databases. After exclusion of irrelevant ones, 21 out of 55 articles were considered for the final analysis. On the basis of this review, majority of the articles reported highest prevalence of stunting in Africa and its progress is found unsatisfactory. Inappropriate complementary feeding practice, maternal under nutrition, household food insecurity, economic growth and maternal education, are identified as the principal determinants of stunting. Some studies confer the determinants of stunting is multidimensional and intertwined. The remaining articles reviewed, noted the synergistic interaction between inadequate dietary intake and disease as the main determinant of stunting. The magnitude of stunting in Africa is found as one of the highest in the world and the trend shows stagnating rather than progress. It is confirmed that the determinants of stunting in the continent are varied and intertwined; showing variations from region to region. It is recommended that; African countries should give more emphasis to fight stunting; further research on target implementation sites is needed before creating health policies. They should also consider the cultural beliefs and socio cultural realities of their population. We therefore encourage policy makers to use facts from this review on creating policies to reverse the situation.

Effectiveness of an educational intervention to improve child feeding practices and growth in rural China: updated results at 18 months of age

Inappropriate complementary feeding practices have led to, in part, significant disparities in growth and nutritional status between rural and urban children in China. A cluster-randomised, controlled trial was implemented in Laishui, China to assess the effectiveness of an educational intervention on caregivers' feeding practices and children's growth. Eight townships were randomly assigned to the intervention or control. Five hundred ninety-nine healthy infants were enrolled at 2-4 months old, and were followed up at ages 6, 9, 12, 15 and 18 months. The intervention group received information on enhanced home-prepared recipes and food preparation and hygiene through group training, counselling and home visit. Key outcomes were children's physical growth, caregivers' knowledge and behaviours on complementary feeding, and the infant and child feeding index (ICFI). Analysis was by intention to treat. The intervention group achieved better knowledge and practices related to complementary feeding, and significantly higher ICFI scores at each follow-up point. Children in the intervention group achieved higher z-scores for weight-for-age (WAZ) and weight-for-height (WHZ) than the control (0.18 vs. 0.01 and 0.49 vs. 0.19, respectively) at 18 months old, and were less likely to have stunted growth (odds ratio = 0.71, 95% confidence interval: 0.53-0.94). Mixed model showed that the intervention group achieved significantly better linear growth over time, including WAZ (P = 0.016), WHZ (P = 0.030) and HAZ (P = 0.078). These results indicated that an educational intervention delivered through local health services can enhance caregivers' knowledge and practices of complementary feeding and ultimately improve children's growth.

Factors associated with inappropriate complementary feeding practices among children aged 6–23 months in Tanzania

Inappropriate complementary feeding is one of the major causes of undernutrition among young children in Tanzania. Prevalence of newly developed World Health Organization complementary feeding indicators and their associated factors were determined among 2402 children aged 6-23 months in Tanzania using data from the 2010 Tanzania Demographic and Health Survey. The survey used a multistage cluster sample of 10 300 households from the eight geographical zones in the country. The prevalence of the introduction of soft, semi-solid or solid foods among infants aged 6-8 months was 92.3%. Of all the children aged 6-23 months, the prevalence of minimum dietary diversity, meal frequency and acceptable diet were 38.2%, 38.6% and 15.9%, respectively. Results from multivariate analyses indicated that the main risk factors for inappropriate complementary feeding practices in Tanzania include young child's age (6-11 months), lower level of paternal/maternal education, limited access to mass media, lack of post-natal check-ups, and poor economic status. Overall, complementary feeding practices in Tanzania, as measured by dietary diversity, meal frequency and acceptable diet, are not adequately met, and there is a need for interventions to improve the nutritional status of young children in Tanzania.

Nutrient composition, functional, sensory and microbial status of popcorn-based (Zea may everta) complementary foods enriched with cashew nut (Anacardiumoccidentale L.) flour

Protein-energy malnutrition among Nigerian children is a major health challenge. This nutrition problem is attributed to the inappropriate complementary feeding practices, low nutritional quality of traditional complementary foods and high cost of quality protein-based complementary foods. Therefore, the aim of this study was to formulate complementary foods from popcorn flour and cashew nut. A quantity (500g) of each popcorn and cashew nut seeds (500g) was processed into fermented, germinated and roasted flours. The blends (40% popcorn, 60% cashew nut) were biochemically evaluated for proximate, minerals and amino acids profile. The microbiological properties and sensory attributes were determined using standard methods. For Protein, the results were 22.48% for germinated popcorn-cashew nut (GPC),20.76% for roasted popcorn-cashew nut (RPC) and 21.82% for fermented popcorn-cashew nut (FPC); values for ogi and Nutrend were 12.60% and 16.27% respectively. With respect to energy value, FPC, GPC, RPC, ogi and Nutrend had 533.85, 516.65, 530.49, 389.88 and 397.68 kcal, respectively. The percentages of total essential amino acids in the composition of the blends were36.9%, 40.7% and 38.9%for FPC, GPC and RPC, respectively; non-essential amino acids contents were 63.1%, 59.3% and 61.1% for FPC, GPC and RPC, respectively. The mineral content, that is, potassium, zinc and magnesium, of formulated samples were higher than those obtained for ogi and Nutrend. The antinutrient composition of FPC was lower than that of GPC and RPC. For the functional properties, water absorption capacity was between 1.83 – 1.93 g/ml, least gelation concentration 12.67 – 14.00 g/ml, swelling capacity 0.40 – 0.74 g/ml, loose bulk density 0.43 – 0.49 g/ml and packed bulk density 0.69 – 0.83 g/ml for the formulated samples. The overall acceptability of FPC was rated higher than GPC, RPC and ogi, but lower than Nutrend. For the microbial status, bacteria count was between 1.00–39.00 x 104 cfu/g, mould1.00–4.00 x 104 cfu/g and yeast 1.00–4.33 x 105 cfu/g. The study concluded that the FPC sample was better than ogi in terms of protein and mineral compositions and comparable in overall acceptance to Nutrend. Therefore, the FPC may be used as a complementary food.

Determinants of inappropriate complementary feeding practices in infant and young children in Bangladesh: secondary data analysis of Demographic Health Survey 2007

Suboptimal and inappropriate complementary feeding practices are one of the major causes of child undernutrition in the first 2 years of life in South Asian countries including Bangladesh. The aim of this study was to use the newly developed World Health Organization infant feeding indicators to identify the potential risk factors associated with inappropriate complementary feeding practices. We used data for 1728 children aged 6-23 months obtained from nationally representative data from the 2007 Bangladesh Demographic and Health Survey to assess the association between complementary feeding and other characteristics using multivariate models. Only 71% of infants were consuming soft, semi-solid and solid food by 6-8 months of age. In the multivariate analysis, mothers who had no education had a higher risk for not introducing timely complementary feeds [adjusted odds ratio (AOR)=2.14; 95% confidence interval (CI): 1.08-4.23, P=0.03], not meeting the minimum dietary diversity (AOR=1.69; 95% CI: 1.14-2.54, P=0.01), minimum acceptable diet (AOR=1.70, 95% CI: 1.09-2.67, P=0.02) and minimum meal frequency (AOR=1.73; 95% CI: 1.20-2.49, P=0.003) than the mothers who had secondary or higher education. Infants born in Sylhet, Chittagong and Barisal division had higher risks for not meeting minimum dietary diversity, meal frequency and acceptable diet (P<0.001). The poorest two quintiles had poor levels of minimum meal frequency but dietary quality improved with age. In Bangladesh addressing the fourth Millennium Development Goal (MDG) target will require substantial improvement in complementary feeding practices. Appropriate Infant and Young Child feeding massages should to be development and delivered through existing health system.

Determinants of inappropriate complementary feeding practices in young children in Sri Lanka: secondary data analysis of Demographic and Health Survey 2006–2007

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006-2007 used a stratified two-stage cluster sample of ever-married women 15-49 years, and included details about foods given to children aged 6-23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) - (introduction of solid/semi-solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6-23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty-four per cent of infants aged 6-8 months were introduced to complementary food. The proportion of infants aged 6-8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6-23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6-11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs.

Comparisons of complementary feeding indicators and associated factors in children aged 6–23 months across five South Asian countries

Improving infant and young child feeding practices will help South Asian countries achieve the Millennium Development Goal of reducing child mortality. This paper aims to compare key indicators of complementary feeding and their determinants in children aged 6-23 months across five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka. The latest Demographic and Health Survey and National Family Health Survey India data were used. The analyses were confined to last-born children aged 6-23 months - 1728 in Bangladesh, 15,028 in India, 1428 in Nepal, 2106 in Sri Lanka and 443 infants aged 6-8 months in Pakistan. Introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency and minimum acceptable diet, and their significant determinants were compared across the countries. Minimum dietary diversity among children aged 6-23 months ranged from 15% in India to 71% in Sri Lanka, with Nepal (34%) and Bangladesh (42%) in between. Minimum acceptable diet among breastfed children was 9% in India, 32% in Nepal, 40% in Bangladesh and 68% in Sri Lanka. The most consistent determinants of inappropriate complementary feeding practices across all countries were the lack of maternal education and lower household wealth. Limited exposure to media, inadequate antenatal care and lack of post-natal contacts by health workers were among predictors of inappropriate feeding. Overall, complementary feeding practices among children aged 6-23 months need improvement in all South Asian countries. More intensive interventions are necessary targeting the groups with sup-optimal practices, while programmes that cover entire populations are being continued.

Complementary feeding practices in South Asia: analyses of recent national survey data by the South Asia Infant Feeding Research Network

South Asian region has the highest global burden of child undernutrition, with almost 41% of children stunted, 16% wasted and 33% underweight. Improved feeding of children less than 2 years of age is particularly important because they experience rapid growth and development, and are vulnerable to illnesses such as acute respiratory infections and diarrhoeal diseases. The present supplement aimed to describe complementary feeding practices in five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka - using the new and updated global complementary feeding indicators and to identify determinants of inappropriate complementary feeding practices. The South Asia Infant Feeding Research Network held a series of workshops to study and discuss the operational guidelines for the new complementary feeding indicators in consultation with regional and international experts. The latest Demographic and Health Surveys for Bangladesh, Nepal, Pakistan and Sri Lanka, and the National Family Health Survey of India were used as data sources. Four key indicators were calculated: introduction of solid, semisolid or soft foods in 6-8 months aged, minimum dietary diversity, minimum meal frequency and minimum acceptable diet in 6-23-month-aged children. Univariate and multivariate logistic regression analyses were performed to identify determinants of poor complementary feeding practices. The papers in this supplement present results of these analyses for each individual country and a comparison between countries. The results have important implications for policies, programmes and research on infant and young child feeding in the region, especially for targeting groups at high risk for suboptimal practices.

Determinants of inappropriate complementary feeding practices in young children in India: secondary analysis of National Family Health Survey 2005–2006

In India, poor feeding practices in early childhood contribute to the burden of malnutrition as well as infant and child mortality. This paper aims to use the newly developed World Health Organization (WHO) infant feeding indicators to determine the prevalence of complementary feeding indicators among children of 6-23 months of age and to identify the determinants of inappropriate complementary feeding practices in India. The study data on 15,028 last-born children aged 6-23 months was obtained from the National Family Health Survey 2005-2006. Inappropriate complementary feeding indicators were examined against a set of child, parental, household, health service and community level characteristics. The prevalence of timely introduction of complementary feeding among infants aged 6-8 months was 55%. Among children aged 6-23 months, minimum dietary diversity rate was 15.2%, minimum meal frequency 41.5% and minimum acceptable diet 9.2%. Children in northern and western geographical regions of India had higher odds for inappropriate complementary feeding indicators than in other geographical regions. Richest households were less likely to delay introduction of complementary foods than other households. Other determinants of not meeting minimum dietary diversity and minimum acceptable diet were: no maternal education, lower maternal Body Mass Index (BMI) (<18.5 kg/m(2)), lower wealth index, less frequent (<7) antenatal clinic visits, lack of post-natal visits and poor exposure to media. A very low proportion of children aged 6-23 months in India received adequate complementary foods as measured by the WHO indicators.

Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary data analysis of Demographic and Health Survey 2006

Inappropriate complementary feeding increases the risk of undernutrition, illness and mortality in infants and children. This study uses a subsample of 1428 children of 6-23 months from Nepal Demographic and Health Survey (NDHS), 2006. The 2006 NDHS was a multistage cluster sample survey. The complementary feeding indicators were estimated according to the 2008 World Health Organization recommendations. The rate of introduction of solid, semi-solid or soft foods to infants aged 6-8 months was 70%. Minimum meal frequency and minimum dietary diversity rates were 82% and 34%, respectively, and minimum acceptable diet for breastfed infants was 32%. Multivariate analysis indicated that working mothers and mothers with primary or no education were significantly less likely to give complementary foods, to meet dietary diversity, minimum meal frequency and minimum acceptable diet. Children living in poor households were significantly less likely to meet minimum dietary diversity and minimum acceptable diet. Mothers who had adequate exposure to media, i.e. who watch television and who listen to radio almost every day, were significantly more likely to meet minimum dietary diversity and meal frequency. Infants aged 6-11 months were significantly less likely to meet minimum acceptable diet [adjusted odds ratio (OR)=3.13, confidence interval (CI)=2.16-4.53] and to meet minimum meal frequency (adjusted OR=4.46, CI=2.67-7.46). In conclusion, complementary feeding rates in Nepal are inadequate except for minimum meal frequency. Planning and promotion activities to improve appropriate complementary feeding practices should focus on illiterate mothers, those living in poor households, and those not exposed to media.

Contribution of inappropriate complementary foods to the salt intake of 8-month-old infants

Complementary feeding is a critical developmental time for establishing variety, and appropriate feeding practices are important. These include recommendations for a maximum intake of sodium (salt), because of the potential harmful effect of excessive intake on the developing kidneys and blood pressure in later life. Sodium intakes were examined to establish, if inappropriate complementary feeding practices were contributing to high intakes. Data were collected from a cohort of 1178 8-month-old infants born in 1991/92, participating in the Avon Longitudinal Study of Parents and Children, using a 3-day dietary records completed by their mothers. Sodium and energy intakes were calculated and infants were categorised into quartiles of sodium intake. Majority of infants were first introduced to solids around 3-4 months, with plain baby rice, rusks and other cereals being the first foods consumed during complementary feeding. In the whole sample, 70% consumed in excess, of 400 mg sodium per day, the maximum UK recommendation for children up to age 12 months. The mean sodium intake for the highest quartile was 1060 mg per day. Infants in this quartile were often consuming cows' milk as a main drink; eating three times the amount of bread compared with the lowest quartile and used salty flavourings such as yeast extract and gravy. Sodium intakes in this cohort of infants were higher than recommendations. Clear and practical education is needed on complementary feeding practice for mothers highlighting what foods to introduce and when. Manufacturers have a responsibility to reduce the sodium content of food products.

Infant- and Young Child-feeding Practices in Bankura District, West Bengal, India

A community-based, cross-sectional descriptive study was conducted during June-July 2008 to assess the infant- and young child-feeding (IYCF) practices in Bankura district, West Bengal, India. In total, 647 children aged less than two years selected through revised 40-cluster sampling using the indicators of the Integrated Management of Neonatal and Childhood Illness (IMNCI) and World Health Organization. The proportions of infants with early initiation of breastfeeding (13.6%) and exclusive breastfeeding under six months (57.1%) and infants who received complementary feeding at the age of 6-8 months (55.7%) were low. Appropriate feeding as per the IMNCI protocol was significantly less among infants aged 6-11 months (15.2%) and children aged 12-23 months (8.7%) compared to infants aged less than six months (57.1%), which could be attributable to low frequency and amount of complementary feeding. The main problems revealed from the study were late initiation of breastfeeding, low rates of exclusive breastfeeding, and inappropriate complementary feeding practices.