Inappropriate Complementary Feeding Research Articles

Maternal Feeding Practices of Children One to Three Years in Collins Chabane Municipality of South Africa

ABSTRACT The aim was to assess maternal feeding practices of children one to three years. A descriptive observational design was employed. The sample consisted of mothers-child dyads. A validated structured questionnaire was used. Data was analyzed using SPSS version 26.0. The nutrition status of the children at birth indicated 11.6% underweight as compared to the time of the study (7.2%), 7.9% were stunted increased to 38.0%, while wasting decreased from 11.4%–2.4%. Early cessation of breastfeeding and inappropriate complementary feeding practices were the factors influencing growth. The prevalence of underweight and wasting were low while stunting and overweight were high.

Study of Factors Associated with Inappropriate Complementary Feeding Among Children Aged 6 to 23 Months, Western Health Region of the Gambia, 2020

Introduction: Inappropriate complementary feeding practices are a major cause of morbidity and mortality in the first two years of life. The aim was to investigate factors associated with inappropriate complementary feeding practices among mothers of children aged 6-23 months in the Western Health Region of The Gambia. Methodology: This was a cross-sectional, descriptive and analytical study conducted from 14 September to 14 October 2020. The study population consisted of mothers of children aged 6 to 23 months attending reproductive and child health clinics and enrolled in the "Every Child Counts - My Child Project" immunization and vaccination program. Simple random sampling was used to select participants using the project. Data were collected by means of a questionnaire administered by telephone interview and concerned the socio-demographic characteristics of the mothers, the professional and economic characteristics of the parents, the socio-demographic characteristics of the children, diet and complementary feeding practices. Results: The mean age of the mothers was 28.3 (±5.4) years and that of the children 14.2 (±4.8) months. Minimum dietary diversity was 33.3%, minimum meal frequency 88% and minimum acceptable dietary intake 14.5% for all children aged 6-23 months. Non-respect of minimum dietary diversity was associated with the child's female sex, with an OR = 16.3 [1.83-145.7], with the occurrence of both diarrhea and Acute Respiratory Infection (ARI) in the two weeks preceding the survey, with an OR = 27.2 [4.26-39.8], and with the child's birth in a public health facility, with an OR = 55.1 [1.53-197.7]. Children whose mothers were aged between 25 and 34 and whose fathers did not work had a higher risk of non-respect of the dietary diversity, with OR = 54.1 [2.4 6- 118.5] and OR = 22.5 [2.32 - 31.9] respectively. The factors associated with non-respect of the minimum meal frequency were the advanced age of the children: 12 to 17 months with an OR= 28.6 [1.65 - 49.5] and 18 to 23 months with an OR= 18.9 [1.67 - 215.0] and a history of both ARI and diarrhea with an OR=. 52,9 [1,61 - 173,7]. Non-respect of the minimum acceptable dietary intake was associated with older children aged 18 to 23 months OR= 14.4 [2.25- 93.0] and those whose mothers had vocational training OR=.24.2 [1.27- 46.3]. Conclusion: Complementary feeding practices are not very satisfactory. It is important to strengthen nutrition education in order to improve infant and young child feeding practices.

Appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months in Bhimphedi rural municipality of Nepal.

Appropriate complementary feeding plays a crucial role in the enhancement of child survival; and promotes healthy growth and development. Evidence has shown that appropriate complementary feeding is effective in preventing malnutrition and child mortality. Thus, the main objective of this study is to assess the prevalence of appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months. A community-based cross-sectional study was conducted from August to December 2018. A total of 259 mothers who had children aged 6-23 months were selected randomly from the 714 eligible mothers. A structured questionnaire was used to collect the data from the respondents. The data were collected in a tablet phone-based questionnaire using the Open Data Kit mobile application by face-to-face interview. Data analysis was done in SPSS version 21. Multivariable logistic regression was used to identify the factor associated with appropriate complementary feeding practice. The prevalence of appropriate complementary feeding practice was 25%. Mother and father with formal education (AOR 6.1, CI: 1.7-22.4 and AOR 5.6 CI: 1.5-21.2 respectively), counseling on IYCF (AOR 4.2, CI: 1.5-12.3), having kitchen garden (AOR 2.4, CI: 1.1-5.2) and food secured family (AOR 3.0, CI: 1.0-8.9) had higher odds of appropriate complementary feeding practice. This study revealed that a significant proportion of mothers had inappropriate complementary feeding practice for their children aged 6-23 months. This study highlights the need for behavior change communication and promotion of kitchen garden to address the associated factors and promote appropriate complementary feeding practice.

Family support is the strongest predictor that influences mother’s self-efficacy level on complementary feedings practices among toddlers in Tengger tribe

PurposeThe low rate of exclusive breastfeeding and the early introduction of complementary feeding are among the causes of nutritional problems in children. The national coverage of exclusive breastfeeding in 2019 was 67.7%, surpassing the target of the 2019 Strategic Plan, which was 50%. However, there are still several practices of early and inappropriate complementary feeding (32.3%) that can be contributing factors to malnutrition problems in children. The purpose of this study was to determine the factors that influence mother’s self-efficacy levels regarding complementary feeding practices among toddlers in the Tengger tribe.Design/methodology/approachThe study conducted was an observational study with a cross-sectional design. It focused on mothers with children aged 6–24 months in Wonokitri village, East Java. Data was collected using a structured questionnaire and information from the local health center. The analysis involved univariate and bivariate analysis using the chi-square test.FindingsMost mothers were aged 20–34 years (78.9%), had a good level of knowledge (61.4%), the last education level of fathers and mothers was high school (47.4%; 54.4%), parents work as farmers (86.0%; 61.4%), Hinduism (98.2%), family income is less than the minimum wage (78.9%), and mothers receive good family support (73.7%). Most toddlers were boys (56.1%), aged 13–24 months (68.4%), and the second child (66.7%). Family support was the only factor that was significantly related to a mother’s self-efficacy in complementary breastfeeding practices (p-value = 0.042).Research limitations/implicationsIt is hoped that more families and health workers will support mothers in giving food to their babies based on the guidelines.Originality/valueThis paper collects evidence from indigenous people of the Tengger tribe.

The influence of feeding practices on under-five nutrition status in Mbinga District, Tanzania

Background: Undernutrition is a universal public health problem for both children and adults globally. It is not only a public health concern but also an impediment to global poverty reduction, productivity, and economic growth. Under-five children are among the most vulnerable groups, although it affects both women, the elderly, and youth. This study assessed the influence of feeding practices on under-five nutrition status in Mbinga District, Tanzania. This paper unveils the contribution of feeding practices to underfive nutrition status in Tanzania. Methods: A cross-sectional study involved 150 heads of households whose children aged 0–59 months were assessed to determine their anthropometric measurements. Weigh for age Z-scores, height for age Z-scores, and weight for height Z-scores. A structured questionnaire was administered to collect data from the heads of households. Data were coded and analyzed by ENA for the SMART, Statistical Package for Social Sciences (SPSS), and STATA programs. Results: It is revealed that 90.7% of under-five children in the surveyed households initiated breastfeeding within one hour of life, 72% of the children were given complementary foods before six months, maize porridge was a major complementary food, and 80% of the children consumed three to four meals per day. Their diets were not diverse as starchy staple foods were dominant. It was further found that 42% of the children were stunted, 33% were wasted, and 25% were underweight. Moreover, the results of the ordered probit regression model showed that exclusive breastfeeding, meal frequency, and food dietary diversity were positively influencing nutrition status, while household size was negatively influencing the nutrition status of the under-five. Conclusion: The study concludes that inappropriate complementary feeding, children did not receive the minimum dietary diversity, and poor child feeding practices have a positive influence on the anthropometric status of the under-five. It was recommended that education be provided to community members on appropriate child feeding practices and family planning.

Probability of Inappropriate Complementary Feeding Practices on Children Aged 6-23 Months in Indonesia: Results of Indonesian Demographic Health Survey in 2017

Background: One of the causes of the double burden of nutrition problems in Indonesia is the early feeding of complementary feeding. The practice of providing complementary feeding in several countries, including Indonesia, has not reached the target and it is not yet known the magnitude of the probability of complementary feeding not following the recommendations in Indonesia based on national survey data. 
 Objective. To identify the risk factors for the failure of Infant and Young Child Feeding (IYCF) practice in urban and rural NTT.
 Objectives: This study aims to determine the Probability of inappropriate complementary feeding practices in Children aged 6-23 Months in Indonesia and the factors that influence it. 
 Methods: The research design uses cross-sectional studies. The data is sourced from the 2017 Indonesian Health Demographic Survey (IDHS) results. The sample was selected from women of childbearing age in IDHS 2017, namely women of childbearing age aged 15-49 years who had children aged 6-23 months who met the inclusion and exclusion criteria of 4,985 children. The data were analysed using multivariate logistic regression. 
 Results: The practice of giving complementary feeding according to recommendations in children aged 6-23 months in Indonesia is only 55.53%. Socio-economic status is very poor (p= 0.000; OR=1.785; 95% CI 1.44-2.213), rural residence (p= 0.000; OR=1.168; 95% CI 1.025-1.33), lower education (p= 0.002; OR=1.398; 95% CI 1.149-1.702), and grande multipara parity (p= 0.001; OR=1.57; 95% CI 1.238-1.992) is significantly associated with the practice of giving complementary feeding not by the recommendations.
 Conclusions: The probability of the practice of giving complementary feeding is not by the recommendation of 86% due to the socio-economic status of very poor families living in rural areas, low maternal education levels, and mothers with grande-multipara parity. It is necessary to improve the socio-economics of the family through the empowerment of mothers and families, increase access to health services in rural areas, improve maternal education through various programs, and intensify family planning programs to limit the number of children in the family.

Barriers to appropriate complementary feeding and the use of ultra-processed foods: A formative qualitative study from rural Oromia, Ethiopia.

Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents)and grandmothers (23 respondents) of children aged 6-23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notesbefore qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuitsand lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored.

Potential risk of stunting in children under five years living by the riverside: A systematic review

Introduction: Stunting, or linear growth failure, is defined by a height-for-age z-score of below -2SD according to WHO growth standard. Stunting can have short-, medium-, and long-term consequences. Rivers have an important role in human life. In several riverside areas, households still depend on the river for their livelihoods and health. This study aimed to explore the prevalence of stunting in children living by the riverside and its related factors. Methods: Epidemiological studies published from PUBMED, MEDLINE via EBSCOHost, Science Direct, ProQuest, and Research Gate databases were systematically searched. The publication period was not restricted. Only open-access and English articles were examined. Results: A total of 20 from 1200 studies were reviewed. The prevalence of stunting ranged from 20% to 48.3%. The other outcomes besides stunting were wasting and underweight status. There were 83 risk factors studied, and the most studied variables were age, gender, diarrhoea, water source, parent’s education, immunisation, and inappropriate complementary feeding practices (6 to 13 studies). Household water sources from rivers and economic status were consistently correlated with stunting. Majority of the risk factors studied were related to nutrition. From the environmental aspect, the most studied risk factors were water sources and sanitation. Conclusion: Children living by the riverside face a significant risk of stunting attributed to the consistent correlation between household water sources from rivers and economic status, affecting various aspects of daily life beyond drinking water. Future research is needed to examine the impact of environmental factors and the behaviours of riverside communities.

Determinants of inappropriate complementary feeding among children 6–23 months of age in Dessie City Northeast Ethiopia: a case-control study

BackgroundInappropriate complementary feeding is one of the leading causes of malnutrition among children 6–23 months old and delays children’s growth milestone. The determinants of inappropriate complementary feeding practice have diverse natures, so that many of the previous studies fail to generate adequate evidence on it. This study aim to address the determinants of in appropriate complementary feedings at community level.MethodsA community-based unmatched case-control study design was carried out among children 6–23 months of age in Dessie City from April 13, 2021 to May 13, 2021. Nine kebeles were selected by simple random sampling method. One month prior to the data collection time survey was conducted and 482 samples were taken from the preliminary survey data; 241 cases and 241 controls by computer generated random numbers. Interviewer administered questionnaire was used to investigate potential determinants of inappropriate complementary feeding practice. Binary logistics regression was used to identify independent determinants.ResultsPart working situation of mother [AOR = 0.21 CI: 0.08, 0.52] was negatively associated with inappropriate complementary feeding. Having no post-natal care visit [AOR = 4.062 CI:2.35,7.02], poor wealth status [AOR = 2.7 CI:1.09,6.68], food in-security [AOR = 4.49 CI:1.94,10.37], home delivery [AOR = 4.33 CI:1.43,13.15], having poor knowledge on infant and young child feeding [AOR = 5.94 CI:2.8,12.6], having no health education on complementary feeding [AOR = 2.54 CI:1.28,5.06] and father’s job [AOR = 2.2 CI:1.17,4.1] were found to be positively associated with inappropriate complementary feeding.ConclusionMothers’ work situation, fathers’ job, wealth index, food security, mothers’ knowledge on infant feeding, post-natal care, health education on infant feeding and place of delivery were independent determinants for inappropriate complementary feeding. Thus, interventions shall effectively address those factors to alleviate the problem.

Spatial variation and determinants of inappropriate complementary feeding practice and its effect on the undernutrition of infants and young children aged 6 to 23 months in Ethiopia by using the Ethiopian Mini-demographic and health survey, 2019: spatial and multilevel analysis.

Inappropriate complementary feeding practices (IACFPs) are major public health issues in Ethiopia, which usually result in stunting and becoming an intergenerational cycle. However, the spatial patterns and determinants of IACFP and its effect on undernutrition are not well understood in Ethiopia. Therefore, the aim of this study was to explore the spatial patterns and determinants of IACFPs and their effects on the undernutrition of infants and young children (IYC) in Ethiopia. This was a nationwide community-based survey study among 1,463 mothers of IYC aged 6-23 months in Ethiopia. The global spatial autocorrelation was assessed using the global Moran's-I to evaluate the spatial clustering of IACFPs. Significant clusters with high and low rates of IACFPs were explored. A multilevel mixed-effect logistic regression with cluster-level random effects was fitted to identify determinants of IACFPs with an AOR and 95% CI. The prevalence of IACFPs was 90.22%. The spatial pattern of IACFP in Ethiopia was clustered across regions (Global Moran's I = 0.63, Z-score = 12.77, value of p ≤0.001). Clusters with a high rate of IACFP were detected in southern, northwest, and eastern Ethiopia. Individual and community-level variables accounted for 63% of IACFP variation. Mothers with no education were 3.97 times (AOR = 3.97; 95% CI: 1.64-9.60) more likely to have IACFPs than those with higher education. The poorest HHs had 4.80 times the odds of having IACFPs as the richest HHs (AOR = 4.80, 95% CI: 1.23-18.71). The odds of having IACFPs were 2.18 times (AOR = 2.18; 95% CI: 1.28-3.72) higher among babies with no postnatal checkup. Non-breastfed IYC were 2.8 times (AOR = 2.80; 95% CI: 1.29-6.10) more likely to have IACFP when compared with breastfed ones. IYC with the inadequate introduction of solid, semi-solid, and soft foods, inadequate minimum dietary diversity, and inadequate minimum acceptable diet were more likely to have wasting, underweight, and stunting. This study showed the prevalence of IACFPs was very high, which had an effect on undernutrition and showed spatial variation in Ethiopia. Therefore, the government of Ethiopia and stakeholders should focus on women with no education and the poorest HHs, encourage PNC checkups, and encourage breastfeeding in the hotspot areas to minimize IACFPs in Ethiopia.

Nutritional Status and its Association with Breastfeeding and Complementary Feeding Practices Among Children visiting Tertiary Care Health Centre

Objective: To assess the nutritional status of children (up to 2 years of age) visiting the National Institute of Child Health (NICH) Karachi and to determine its association with breastfeeding and complementary feeding practices.
 Study Design: Cross-Sectional Study.
 Place and Duration of Study: Outpatient Department, National Institute of Child Health, Karachi Pakistan, from Jan to Jun 2021.
 Methodology: Children aged 1 to 24 months were included. Demographic information, weight, height, weight for height and grade of malnutrition using WHO criteria were checked and categorized as median, -1S.D, -2S.D, -3SD and -4 SD. Face-to-face interview with the mother was conducted using a semi-structured questionnaire based on WHO Infant and Young Child Feeding guidelines to find out the breastfeeding and complementary feeding practices of the mother.
 Results: A total of 355 children were enrolled with a mean age of 9.18±5.90 months. Median SD was attained by 65(18.3%) children, 177(49.9%) infants lied within -1SD(mild malnutrition), 77(21.4%) within -2SD(moderate malnutrition) while 36(10.1%) had severe malnutrition including 26(7.3%) within -3SD and 10(2.8%) within -4SD. Exclusive breastfeeding for up to 6 months had a significantly lower frequency of severe malnourishment (p-value<0.001). Complimentary feeding practices, including the age of initiation, dietary diversity and food frequency, also had a significant association with nutritional status (p-value<0.01).
 Conclusion: Inappropriate breastfeeding and complementary feeding lead to poor health and malnutrition. Exclusive breastfeeding till six months and the introduction of complementary feeding on time with adequate diversity and frequency are critical to the infant’s health.

Determinants of Inappropriate Complementary Feeding Practice among 6 months-2 years old children attending Institute of Child and Mother Health (ICMH), Dhaka

Determinants of Inappropriate Complementary Feeding Practice among 6 months-2 years old children attending Institute of Child and Mother Health (ICMH), Dhaka

The association between complementary feeding practice and linear growth faltering among Cambodian children: an analysis of the 2014 Cambodia Demographic and Health Survey

Background Inappropriate complementary feeding is a factor contributing to linear growth faltering in early childhood. We aimed to assess complementary feeding practice and investigate its association with linear growth faltering among children aged 6 to 23 months among children aged 6-23 months in Cambodia. Methods This study is a secondary data analysis of the 2014 Cambodia Demographic and Health Survey (CDHS). Multivariable linear regression analysis was used to investigate associations between complementary feeding practice and linear growth faltering as length-for-age z-scores (LAZ), adjusted for all covariates. Results This study included 1381 children aged 6 to 23 months. The prevalence of age-appropriate complementary feeding practice was low in Cambodia. Only 23% of the children met all three criteria of minimum dietary diversity, minimum meal frequency, and age-appropriate breastfeeding. Approximately 30% of children aged 6 to 11 months met the minimum dietary diversity requirements and less than 40% of children aged 18 to 23 months were provided breastfeeding after the introduction of complementary food. This study found that there is no relationship between food diversity and feeding frequency and child linear growth. However, the provision of both complementary food and breast milk was independently and negatively associated with linear growth (β-Coefficient=-0.38, 95% confidence interval, CI=-0.60, -0.16). Positive effects on child linear growth, after controlling for all covariates, included the richer (β-Coefficient=0.36, 95% CI=0.07, 0.66) and richest (β-Coefficient=0.50, 95% CI=0.20, 0.79) quintiles of households, as well as appropriate water treatment before drinking (β-Coefficient=0.22, 95% CI=0.05, 0.40). Conclusions Most Cambodian young children aged 6 to 23 months received inappropriate complementary feeding. This study suggests that from the time of conception there is a necessity to improve maternal and child nutrition educational intervention for mothers, including feeding and hygiene practices.

“Just give her a banana”: An ethnographic exploration of causes of stunting in Aceh, Indonesia

Thirty-seven percent of children in Aceh suffer from stunting. This number is concerning. Several programs offering supplementary nutrition for children in hot areas have been conducted. However, the percentage is decreasing too slowly. It is unclear why those programs were ineffective. The study aims to explore the cause of stunting in children aged 25-59 months in the Kota Sigli Sub-district, Pidie Regency, Aceh, Indonesia. Qualitative research was conducted on January 2022 using ethnographic tools. Data were collected through participant observation, semi-structured interviews with eight (8) mothers of stunted children, and informal interviews with midwives. Result, the findings show that there are various factors that may influence the incidence of stunting in children: failure to provide exclusive breastfeeding, inappropriate complementary feeding, and problems with hygiene and sanitation that affect children’s health. In conclusion, this calls for an integrated approach to engaging the Indonesian government, parents, and communities in overcoming the root of the stunting problem: poverty.Keywords:

Nutritional Factors Affecting Stunting Among Toddlers

Background: Stunting is one of Indonesia's most serious nutritional issues. Malang Regency has a 12 percent prevalence of stunting in 2020, with Gondanglegi sub-district having 942 stunted children. One effort to improve toddler nutrition is the administration of colostrum, exclusive breastfeeding, and complementary feeding. Inappropriate colostrum administration, exclusive breastfeeding, and complementary feeding can all increase the risk of stunting in toddlers. 
 Aims: this study aimed to identify the factors that cause stunting in toddlers based on their behavior in meeting their nutritional needs in Gondanglegi sub-district, Malang Regency.
 Methods: A total of 136 children aged 6 to 59 months were divided into two equal groups for the case-control study. The research was carried out at Ketawang and Gondanglegi Primary Health Centers in Indonesia's Gondanglegi sub-district. Weight and height measurements, a questionnaire-based interview, and a 24-hour food recall were all collected. With a significance level of 0,05, Chi-square was used to determine the factors influencing stunting. To perform multivariate analysis, logistic regression was used.
 Results: Colostrum administration, exclusive breastfeeding, and complementary feeding were all linked to stunting in bivariate analysis (p< 0.05). According to a multivariate analysis, exclusive breastfeeding (OR=4,8) is strongly associated with stunting among toddlers in Gondanglegi sub-district, Malang Regency, Indonesia. 
 Conclusion: Breast milk contains many nutrients and antibodies that can protect babies from infection by reducing the duration and severity of illness that can lead to chronic malnutrition and stunting.

Empowering Cadres Through the Practice of Processing and Providing MP ASI in the Context of Stunting Prevention

Giving complementary feeding properly is not only to meet children's nutritional needs but also to stimulate children's eating skills. However, there are still many inappropriate complementary feeding practices, due to the lack of knowledge of mothers and the lack of available information. The cadres of Integrated Healthcare Centre (POSYANDU) as an extension of health workers are expected to be able to provide mothers with adequate information and skills regarding the proper practice of giving and processing complementary feeding. The purpose of this community service is to increase the knowledge of cadres regarding the practice of giving complementary feeding and the skills of cadres in processing the menu of complementary feeding. This community service involved 30 posyandu cadres in Rejosari Village. Activities carried out in the form of counseling accompanied by the practice of menu processing. Based on the results of the evaluation, the knowledge level of cadres has increased, which means that the cadres are considered to have understood and have been able to disseminate information related to proper complementary feeding practices and have been able to process the menu.

Exploratory study on factors influencing the introduction of complementary feeding amongst caregivers of children between 6 and 24 months of age in Polokwane, Limpopo province.

Complementary feeding should be introduced at six months to meet infants' growing nutritional needs. Inappropriate complementary feeding poses threats to the health, development and survival of infants. The Convention on the Rights of the Child states that every child has the right to good nutrition. Caregivers should ensure that infants are fed properly. Factors such as knowledge, affordability and availability impact complementary feeding. Hence, this study explores factors influencing complementary feeding amongst caregivers of children between the age of six and 24 months in Polokwane, Limpopo province, South Africa. A qualitative phenomenological exploratory study design was used to collect data from 25 caregivers, using purposive sampling; the sampling size was dependent on data saturation. Data were collected through one-on-one interviews using voice recorders and field notes for non-verbal cues. Data were analysed using the eight steps of Tesch's inductive, descriptive and open coding technique. Participants had knowledge about when and what to introduce during complementary feeding. Participants alluded that availability and affordability, maternal beliefs about infant hunger cues, social media, attitudes, returning to work because of the end of maternity leave and painful breasts affect complementary feeding. Caregivers introduce early complementary feeding because of returning to work at the end of maternity leave and painful breasts. Additionally, factors such as knowledge about complementary feeding, availability and affordability, mother's beliefs about child hunger cues, social media and attitudes influence complementary feeding.Contribution:There is a need to establish credible social media platforms to disseminate appropriate complementary feeding messages. The established credible social media platforms must be promoted, and caregivers must be referred from time to time.

Infections and nutrient deficiencies during infancy predict impaired growth at 5 years: Findings from the MAL-ED study in Pakistan.

Socio-economic, nutritional, and infectious factors have been associated with impaired infant growth, but how the presence of these factors during infancy affects growth around 5 years is not well understood. This secondary analysis of the MAL-ED cohort included 277 children from Pakistan for whom socio-demographic, breastfeeding, complementary foods, illness, nutritional biomarkers, stool pathogens and environmental enteropathy indicators between 0 and 11 months were recorded. We used linear regression models to analyze associations of these indicators with height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WLZ) at 54-66 months (~5 years), and Poisson regression with robust standard errors to estimate risk ratios for stunting and underweight ~5 years, controlling for gender, first available weight, and income. Among the 237 infants followed longitudinally and evaluated at about 5 years of age, exclusive breastfeeding was short (median = 14 days). Complementary feeding started before 6 months with rice, bread, noodles, or sugary foods. Roots, dairy products, fruits/vegetables, and animal-source foods were provided later than recommended (9-12 months). Anemia (70.9%), deficiencies in iron (22.0%), zinc (80.0%), vitamin A (53.4%) and iodine (13.3%) were common. Most infants (>90%) presented with diarrhea and respiratory infections in their first year. At ~5 years, low WAZ (mean-1.91 ± 0.06) and LAZ (-2.11 ± 0.06) resulted in high prevalence of stunting (55.5%) and underweight (44.4%) but a relatively low rate of wasting (5.5%). While 3.4% had concurrent stunting and wasting ~5 years, 37.8% of children had coexisting stunting and underweight. A higher income and receiving formula or dairy products during infancy were associated with a higher LAZ ~5 years, but infant's history of hospitalizations and more respiratory infections were associated with lower LAZ and higher risk of stunting ~5 years. Infants' intake of commercial baby foods and higher serum-transferrin receptors were associated with higher WAZ and lower risk of underweight ~5 years. Presence of Campylobacter and fecal neopterin >6.8 nmol/L in the first year were associated with increased risk of underweight ~5 years. Growth indicators ~5 years were associated with poverty, inappropriate complementary feeding, and infections during the first year of life, which supports the early start of public health interventions for preventing growth delay ~5 years.

Influence of eating concept on eating behavior and stunting in Indonesian Madurese ethnic group

Background and objectivesStunting is a serious public health problem in Indonesia. Madura Island, which is inhabited by the Madurese ethnicity, had a very high stunting prevalence. The cultural factors of stunting mainly focus on food, food taboos, and early complementary feeding or prelacteal feeding practices. Therefore, this study aims to analyze the eating concept and its association with child feeding practices and stunting among the Madurese ethnic group in Indonesia.MethodsThis qualitative study was conducted in Sampang District, Madura Island, East Java, Indonesia. A total of 61 informants participated in this study (25 informants of in-depth interviews, 26 informants of FGDs, and 10 families in observations). Data collection consists of culture, values, and beliefs in child feeding practices that influence children’s nutritional status. The analysis used was content analysis by emphasizing the meanings, themes, and concepts of eating and stunting.Results and conclusionsStunting was considered a normal condition rather than a nutritional problem. The concept of eating is “eating rice.” Eating without other dishes is acceptable as long as there is rice on the plate. This concept affects inappropriate complementary food feeding practices and malnutrition among children under five. Overall, the study contributed to the improvement of the stunting reduction program by addressing how Madurese thought about eating and stunting.

Associations of Complementary Feeding Practice History and Protein Adequacy Level with Childhood Stunting in the Working Area of Puskesmas Bantaran in Probolinggo Regency

Stunting is often associated with too early complementary feeding time and inadequate protein intake. The purpose of this study was to analyze the relationship between the practice of complementary feeding and the level of protein adequacy with the incidence of stunting in toddlers in the working area of Puskesmas Bantaran Probolinggo regency, East Java. Research used observational analytic with retrospective case control design. The sample were 22 stunted group and 22 non-stunted control group who met the inclusion criteria, and taken by simple random sampling. The sample was a stunting locus village toddler in the working area of Puskesmas Bantaran, Probolinggo Regency with mother as respondents. Data collection instruments included questionnaires of characteristic, SQ-FFQ to assess protein adequacy, and microtoise to measure height. Analysis using Chi-Square and Spearman test. The results showed that stunted toddlers get inappropriate complementary feeding (81.8%) and deficit of protein intake (81.8%). Non-stunted toddlers get the right complementary feeding practices (63.6%) and adequate protein intake (59.1%). There is a relationship between the practice of complementary feeding (p=0.002, OR=7.87) and the level of protein adequacy (p=0.005, OR=6.5) with the incidence of stunting in toddlers. The conclusion of this study is that toddlers with improper complementary feeding practices are 7.87 times higher risk of stunting and toddlers with adequate levels of protein deficit are 6.5 times higher risk of stunting. Mothers should be able to increase the amount of protein intake and proper complementary feeding.