Infant And Young Child Feeding Indicators Research Articles

Evaluation of Complementary Feeding Indicators Among Children Aged 6–23 Months According to the Health Literacy Status of Their Mothers

Background/Objectives: Infant and young child feeding (IYCF) practices directly affect child health, development, and survival, especially under 2 years of age and ultimately affect adult life well-being. As the primary caregivers of the children, mothers with higher health literacy may better perceive the benefits of optimal complementary feeding practices, leading to improved health outcomes for their children. In this study, we aimed to assess complementary feeding practices among children aged 6–23 months in Turkey according to 2021 World Health Organization IYCF indicators [minimum dietary diversity (MDD); minimum meal frequency (MMF); minimum acceptable diet (MAD); egg and/or flesh food consumption (EFF); sweet beverage consumption (SwB); unhealthy food consumption (UFC); zero vegetable or fruit consumption (ZVF); and bottle feeding (BoF)] and investigate their associations with sociodemographic characteristics and mothers’ health literacy. Methods: With a descriptive study design, we reached 572 mothers of children aged 6–23 months from five regions of Turkey. We used the Turkey Health Literacy Scale-32 (TSOY-32) to assess mothers’ health literacy. Results: While maternal and child age are significantly associated with more complementary feeding practices, specifically MDD, MAD, and EFF, having multiple children has negative impacts on several complementary feeding indicators, including MDD, MMF, MAD, UFC, and ZVF. The only indicator associated with mothers’ TSOY-32 scores was zero fruit and vegetable consumption. Conclusion: Raising awareness among mothers about the importance of complementary feeding practices and identification of vulnerable groups will guide practitioners and policymakers to improve child health and nutrition.

The Role of Complementary Feeding Practices in Addressing the Double Burden of Malnutrition among Children Aged 6-23 Months: Insight from the Vietnamese General Nutrition Survey 2020.

Background/Objectives: Optimal infant and young child feeding (IYCF) practices are crucial to addressing the double burden of malnutrition (DBM), encompassing undernutrition (including micronutrient deficiencies) and overnutrition. This study examined the demographic and socioeconomic determinants of IYCF practices, and their impacts on the DBM among 2039 Vietnamese children aged 6-23 months from the General Nutrition Survey 2020. Methods: Thirteen IYCF indicators recommended by the WHO/UNICEF were evaluated. Associations between IYCF indicators and outcome variables were assessed using logistic regressions. Results: The prevalence of stunting, underweight, and overweight subjects was 10.9%, 5.6%, and 3.1%, respectively. Low serum zinc affected 56.7% of children, while 14.3% had low serum retinol, 31.2% had anemia, and 34.6% had iron deficiency (ID). Only 36.7% of children achieved minimum dietary diversity (MDD), and 29.0% achieved the minimum acceptable diet (MAD). Children from the younger age group (6-11 months), ethnic minorities, those living in rural/mountainous regions, and poorer wealth quintiles had reduced odds of meeting IYCF criteria, including MDD and MAD. Infants meeting MDD had reduced odds of stunting [adjusted odds ratio (95% confidence intervals): 0.61 (0.41, 0.92)], and ID [0.69 (0.54, 0.88)]. Children meeting MAD had reduced odds of anemia [0.72 (0.57, 0.91)], ID [0.66 (0.52, 0.84)], and low serum retinol [0.63 (0.41, 0.99)]. Continued breastfeeding (12-23 months) reduced the odds of being underweight [0.50 (0.27, 0.92)] and of having low serum zinc [0.70 (0.52, 0.96)]. Adequate minimum milk feeding frequency had increased odds of being overweight [3.33 (1.01, 11.09)]. Conclusions: Suboptimal IYCF practices were significant predictors of the DBM among Vietnamese children, with evident age-specific, geographical, and socioeconomic disparities.

Cognitive Interviewing to Improve Infant and Young Child Dietary Assessments in the Nepal Demographic and Health Survey

BackgroundThe Demographic and Health Survey (DHS) is the primary source of nationally representative nutrition data for many countries and is important in shaping national nutrition policy, advocacy, and research. Without careful testing and adaptation to local contexts, findings are at risk of inaccurately representing respondents’ behaviors and key nutritional indicators. ObjectivesThis study used a cognitive interviewing approach to assess mothers’ comprehension, retrieval, judgment, and response to the infant and young child feeding (IYCF) dietary assessment module questions in the Nepal DHS-8 Woman’s Questionnaire. MethodsA cross-sectional qualitative study was conducted in December 2021, using semistructured cognitive interviews, among 54 mothers of children 6–23 mo of age across 3 regions of Nepal. Interviews were analyzed to identify issues in participant understanding of questions, as well as cognitive challenges or benefits of a longer introduction to the IYCF dietary assessment module, as compared with the original shorter introduction and challenges or benefits to using closed-ended compared with open-ended questions. ResultsCognitive challenges were identified, including issues with judgment of certain food categories resulting in misclassification, comprehension of certain concepts, and comprehension of certain instructions for the dietary assessment that resulted in the variability of food and liquids recalled by mothers. ConclusionsThese findings carry substantial implications for the measurement of the diet quality of infants and young children (IYC) in Nepal, and similar cognitive challenges may exist in other contexts. Although this current study is not able to answer the exact extent to which the accuracy and precision of IYCF indicators are affected by these cognitive challenges, these findings indicate that current measurements may be subject to over or underestimation and there is a need for further research in this area to understand the degree of measurement error related to these challenges.

Diet quality and nutritional status of HIV-exposed children aged between 6 and 18 months in the Greater Accra Region of Ghana

IntroductionHIV-exposed children, even when uninfected, have a greater risk of malnutrition than unexposed counterparts. WHO guidelines recommend children aged 6–23 months be fed a variety of foods to meet nutrient requirements. This study aimed to determine infant and young child feeding (IYCF) practices among HIV-exposed children under 2 years old enrolled in a dietary intervention and to explore correlates of the IYCF indicators and associations between IYCF and nutritional status.MethodologySix hundred and eighty mother–child pairs were recruited from 19 health facilities from the Greater Accra Region. The sociodemographic data, anthropometry, hemoglobin, and dietary intake were recorded.ResultsNinety-five percent of HIV-positive mothers breastfed their babies, and 53% initiated breastfeeding in a timely manner. Around one in five mothers (21%) introduced liquids other than breastmilk to their children within the first 2 days of birth, and only around one in four children (26%) aged 12–23 months had received breast milk on the day before assessment. Ninety-three percent of babies between 6 and 8 months had been introduced to solid, semi-solid, or soft foods. Eighteen percent of children reached the threshold for Minimum Dietary Diversity (MDD) by eating from over five of eight food groups. Fifty-four percent received Minimum Meal Frequency (MMF), eating between 2 and 4 meals in a day. Eleven percent received the Minimum Acceptable Diet (MAD). Thirty-two percent were anemic. Underweight and stunting were 12 and 11%, respectively. Children of mothers aged 31–40 years were more likely to meet the MDD and MAD [OR = 2.8, 95%CI (1.185, 6.519), p < 0.05 and OR = 2.8, 95%CI (1.256, 6.279), p < 0.05] compared to children of mothers aged 30 years or less or aged above 40 years. Children from households earning more than GHS 500 were more likely to meet MMF than those from households earning less. No associations were found between IYCF and nutritional status.ConclusionFindings highlight the need for nutrition programs to educate HIV-exposed children’s caregivers on optimal feeding practices. The importance of continued breastfeeding and dietary diversity needs to be highlighted. Affordable, iron-rich foods should be promoted. Special attention should be paid to younger, less educated, and lower socioeconomic status mothers.

Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6-23 months: Results from a national survey in Ghana.

Stunting and wasting are key public health problems in Ghana that are significantly linked with mortality and morbidity risk among children. However, information on their associated factors using nationally representative data is scanty in Ghana. This study investigated the influence of Infant and Young Child Feeding (IYCF) indicators, socio-demographic and economic related factors, and water and sanitation on stunting and wasting, using nationally representative data in Ghana. This is a secondary data analysis of the most recent (2017/2018) Ghana Multi-Indicator Cluster Survey (MICS) datasets. The multi-indicator cluster survey is a national cross-sectional household survey with rich data on women of reproductive age and children under the age of five. The survey used a two-stage sampling method in the selection of respondents and a computer-assisted personal interviewing technique to administer structured questionnaires from October 2017 to January 2018. The present study involved 2529 mother-child pairs, with their children aged 6 to 23 months. We used the Complex Sample procedures in SPSS, adjusting for clustering and stratification effects. In a bivariate logistic regression, variables with P-values ≤ 0.05 were included in a backward multivariate logistic regression to identify the significant factors associated with stunting and wasting. The mean age of children was 14.32 ± 0.14 months, with slightly more being males (50.4%). About 12% and 16% of the children were wasted and stunted, respectively. There were 39.4%, 25.9%, and 13.7% of children who, respectively, satisfied the minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). None of the IYCF indicators was significantly associated with stunting or wasting in the multivariate analysis but low socio-economic status, low birth weight, being a male child and unimproved toilet facilities were significantly associated with both wasting and stunting. Our findings suggest that aside from the pre-natal period, in certain contexts, household factors such as low socio-economic status and poor water and sanitation, may be stronger predictors of undernutrition. A combination of nutrition-specific and nutrition-sensitive interventions including the pre-natal period to simultaneously address the multiple determinants of undernutrition need strengthening.

Validation of selected 2021 infant and young child feeding indicators for appropriate complementary feeding in relation to dietary adequacy and anthropometric status

Introduction: With the new set of 2021 infant and young child feeding (IYCF) indicators released by WHO and UNICEF, there is a need for its validation in the Philippine setting. The study evaluated the validity of cut-off points used for minimum dietary diversity and minimum feeding frequency in terms of micronutrient and energy intake adequacy, respectively, and minimum acceptable diet (MAD) in relation to anthropometric status. Methods: The study covered 8360 infants and young children aged 6-23.9 months with complete information on IYCF, anthropometric measurements, maternal information, and household characteristics from the 2018-2019 Expanded National Nutrition Survey (ENNS). Bivariate and correlation analyses using STATA version 15 (Corp LLC, Texas, USA 2017) were performed to determine the association of specific IYCF indicators: dietary diversity and feeding frequency with nutrient and energy intake adequacy, and MAD with anthropometric status. Sensitivity and specificity analyses were performed to evaluate the accuracy of dietary diversity score (DDS) and feeding frequency in identifying children with adequate nutrient and energy intakes, respectively. Results: Significant associations were found between DDS and micronutrient adequacy, and between feeding frequency and energy intake adequacy, regardless of breastfeeding status. A DDS of 5 and 6 and feeding frequency of 4-5 and 8 maximised sensitivity and specificity in identifying breastfed and non-breastfed children meeting 100% nutrient and energy adequacy, respectively. Conclusion: The selected 2021 complementary feeding indicators are practical guidelines to reflect dietary adequacy, but may not capture the entire process related to nutritional outcomes, especially stunting.

Deteriorating complementary feeding practices and dietary quality in Jordan: Trends and challenges.

Quality complementary feeding (CF) of infants and young children is key to their growth and development. But in Jordan, providing appropriate CF remains a challenge. This study assesses trends in infant and young child feeding (IYCF)practices, and consumption by infants and young children aged 6-23 months of breast milk substitutes (BMSs), sugar-sweetened beverages (SSBs), and micronutrient-rich foods in Jordan from 1990 to 2017. We combined dietary data on infants and young children from six Demographic and Health Surveys (DHS)(n = 14,880 children) to compute IYCF indicators. The latter included minimum dietary diversity (MDD),minimum meal frequency (MMF),and minimum acceptable diet (MAD),as well as intake of micronutrient-rich foods and food groups, specific SSBs, and infant formula. We conducted trend analyses using logistic regression models adjusted for child's age in month, child age squared, governorates, urban/rural residence, mother's educational attainment, and household wealth quintiles. We found that the proportion of consumption of micronutrient-rich food groups declined significantly between 1990 and 2017, with fewer infants and young children consuming eggs (OR = 0.39, p ≤ 0.001, 2002 reference), meat, poultry, and fish (OR = 0.25, p ≤ 0.001, 2002 reference), dairy (OR = 0.59, p ≤ 0.001, 2002 reference) and Vitamin A-rich fruits and vegetables (OR = 0.66, p ≤ 0.001, 2002 reference). Conversely, there was increased use of BMSs and sugar-sweetened juices that paralleled a decline in the share of infants and young children meeting appropriate CF practices and consuming micronutrient-rich foods and food groups. By 2017, children aged 6-23 months were significantly less likely to meet MDD, MMF, and subsequently MAD; the odds of consuming BMSs were almost three times the reference (OR = 3.8, p ≤ 0.001, 1990 reference), as werethe odds of consumingsugar sweetened juices (OR = 3.63, p ≤ 0.001, 1990 reference). Food insecurity and undernutrition are low in Jordan; however, overweight and obesity rates are increasing concurrently as are micronutrient deficiencies. This highlights the need for policymakers to address factors at individual and household levels (behaviours and practices) as well as environmental issues (increasing access to unhealthy and ultraprocessed foods).

Association between household food security and infant feeding practices among women with children aged 6-23 months in rural Zambia.

Infant and young child feeding (IYCF) practices directly affect the nutritional status of children under two years of age, ultimately impacting their survival. However, ensuring that newborns and young children are fed according to the WHO-recommended practice has proven to be a challenge in many developing nations, especially in households that face food insecurity. This study aims to determine the association between IYCF practices and household food security's availability and access dimensions in rural Zambia. The study uses data from a cross-sectional survey of 2,127 mother-child pairs drawn from 28 rural districts in 8 out of the 10 Zambian provinces. Logistic regression analysis was used to examine the association of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet with measures of household food security such as household dietary diversity score, and food insecurity experience scale, while controlling for confounding variables. The results show that children living in households classified as being food-secure based on the household dietary diversity score were significantly more likely to achieve appropriate feeding practices on all three IYCF measures, even after controlling for confounding factors. Notably, poor IYCF practices exist even in food-secure households, as most children in these households still need to receive a minimum acceptable diet. Although living in a household classified as food secure based on the access dimensions of household dietary diversity score and food insecurity experience scale is significantly associated with improvements in all three IYCF indicators even after controlling for confounding factors, the relationship does not hold for the availability measure of months of adequate household food provisioning. These findings highlight the need for targeting specific dimensions of household food security to solve child malnutrition, especially in rural areas. The focus should go beyond basic food availability, ensuring adequate diversity, and enhancing knowledge of appropriate feeding practices.

Infant and Young Child Feeding practices up to 23 months in Namuno District, Cabo Delgado, Mozambique

BackgroundInadequate breastfeeding and complementary feeding practices are key determinants of child malnutrition and impact one-third of the under-five mortality rate worldwide. The district of Namuno in Cabo Delgado (Mozambique) has been long registering a high prevalence of acute malnutrition. To date, no data exists about Infant and Young Child Feeding (IYCF) practices in the area. The current pilot study explores the feeding practices among children aged 0–23 months in Namuno and sets out its main drivers.MethodsThis cross-sectional study was realized between August and September 2019 and drew on questionnaires for mothers/caregivers of children aged 0 to 23 months. We computed IYCF indicators and correlated them with mothers’/caregivers' school attendance, delivery setting, and distance between home and the place where livelihood activities took place (workplace), using univariate and multivariate (age-adjusted) logistic regression analysis.ResultsThe survey was data derived from a sample of 632 mothers/caregivers. 62% of 0–23-month-old children received colostrum whilst only 31% of 0–5 months babies were on exclusive breastfeeding (EBF). Among 6–23 months old children, 17% consumed foods and beverages from at least five out of eight defined food groups, 31% received a minimum frequency of meals, and 23% had a minimum acceptable diet. Data revealed a positive correlation between early initiation of breastfeeding and delivery in a maternity ward (OR 6.9, CI 3.2–16.1, p-value < 0.001). No difference in the IYCF indicators between female and male babies was detected.ConclusionsIn the Namuno district, IYCF practices did not fulfill WHO/UNICEF’s indicators and recommendations. This suggests that efforts should be focused on EBF-enabling interventions to improve children’s dietary consumption patterns.

Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania

BackgroundInadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development. ObjectivesTo assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania. MethodsEarly feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6–18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level. ResultsThe MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations. ConclusionsPoor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.

Maternal autonomy but not social support is a predictor of child feeding indicators in the Northern Region, Ghana

BackgroundChild malnutrition may be mediated by poor infant and young child feeding (IYCF) practices. This study sought to explore if maternal social support or autonomy was related to IYCF indicators in Northern Region, Ghana.MethodsAn analytical cross-sectional study was conducted with 395 randomly sampled mother–child pairs from 8 health facilities. Data were collected on socio-demographic characteristics, social support and autonomy statuses of mothers, and dietary intake and anthropometry of children. Maternal social support and autonomy statuses were derived and classified into tertiles and IYCF and child growth indicators were derived based on WHO protocol. Logistic regression analysis was used to explore the association of maternal social support and autonomy statuses to IYCF indicators and child nutritional status.ResultsThe mean age of the women was 27 (± 5.10) years and most belonged to the lowest tertile of social support (52.4%), and autonomy (44.1%). About half of the children, 53.2% and 44.6%, received Minimum Dietary Diversity (MDD) and Minimum Acceptable Diet (MAD) respectively but the majority (72.9%) received Minimum Meal Frequency (MMF). About a fifth of the children, 21.0%, 24.1%, and 20.5%, were wasted, stunted, and underweight respectively. Maternal autonomy was associated with IYCF but not growth indicators of young children. Compared to children of mothers of richest autonomy tertile, children of women of middle autonomy tertile were 67% less likely to receive MDD [Adjusted Odds Ratio (AOR): 0.33; 95% Confidence Interval (CI): 0.18–0.59], and 56% less likely to receive MAD (AOR: 0.44; 95% CI: 0.24–0.77). Also, children belonging to mothers of poorest autonomy tertile were 56% less likely to receive MMF compared to children of richest maternal autonomy tertile (AOR: 0.44; 95% CI: 0.23–0.84).ConclusionMaternal autonomy and not social support is associated with IYCF indicators of children in Northern Ghana; child survival programmes should incorporate or strengthen women empowerment interventions to improve child nutrition.

Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey

BackgroundNurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices.MethodsWe did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators.ResultsThe prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children’s books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices.ConclusionsSuboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal.

Evolution of infant feeding practices in children from 9 to 24 months, considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL-ED study.

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.

Child feeding practices in rural Ethiopia show increasing consumption of unhealthy foods.

The quality of complementary feeding can have both short- and long-term health impacts by delaying or promoting child growth and establishing taste preferences and feeding behaviours. We aimed to assess the healthy and unhealthy feeding practices of infants and young children in rural Ethiopia. We conducted two rounds of surveys in December 2017/18 in Habru district, North Wello, rural Ethiopia among caregivers of infants and young children (N = 574). We characterised the consumption of infants and young children using non-quantitative 24 h recall and the World Health Organization infantand young child feeding indicators. Sociodemographic characteristics, anthropometryand haemoglobin concentrations were assessed. Breastfeeding was a norm as 82% and 67% were breastfed in the first and second rounds. Between the two rounds, dietary diversity increased from 5% to 17% (p < 0.05), but more pronounced increases were observed in the consumption of ultra-processed food(UPFs). Up to one-in-five (22%) of the children consumed UFPs. With an average of only three food groups consumed, the consumption of nutrient-dense foods like animal source foods, fruits and vegetables was very low particularly among younger children. UPFs are an additional risk factor that contributes to poor quality diets. Behavioural Change Communication interventions, including those in rural areas, should explicitly discourage the consumption of UPFs. Future studies should aim to quantify the amount of UPFs consumed and evaluate how this is associated with diet adequacy and nutritional outcomes.

Comparison of the agreement between WeChat-based self-administered and interviewer-administered data on infant and young child feeding in China: A test-retest study.

BackgroundMeasuring infant and young child feeding (IYCF) indicators is important in evaluating child health programs and making evidence-based decisions. With Internet and new media rapidly developing, communication apps such as WeChat (the most popular mobile social media platform in China) are widely used and can potentially be used as an alternative way to collect infant and young child feeding information. This study compares data agreement between a WeChat-based self-administered and an interviewer-administered survey on infant and young child feeding information.MethodsWe recruited 297 mothers of children aged 6-23 months in Fenxi County, Shanxi Province, China. Using the Test-Retest method, we first collected data through a self-administered survey using a WeChat-based electronic questionnaire and asked 36 questions on breastfeeding and complementary feeding knowledge, practices, and information sources. We then conducted an interviewer-administered survey using the same questionnaire and compared the data agreement between the two survey methods during the same day. Cohen's kappa score (κ) and intraclass correlation coefficients (ICC) were used for data agreement analysis for all 36 questions and six key IYCF indicators. The McNemar test was used to identify differences between the two survey methods for the six key indicators.ResultsThere was substantial or almost perfect agreement for 33 questions (κ/ICC>0.60), and slight or fair agreement for the other 3 questions (κ/ICC<0.40). Agreement of all six key IYCF indicators was substantial or almost perfect (κ = 0.78-0.94), while two indicators showed statistical differences between the two survey methods (P = 0.03 for “Minimum meal frequency” and P = 0.001 for “Minimum accepted diet”). Analysis of reasons for inconsistencies showed that 43.6% of all the inconsistencies were not caused by the self-administered survey method. The cost of the interviewer-administered survey was much higher than that of the self-administered survey: ¥45.9 (US$6.8) vs ¥19.7 (US$2.9) per questionnaire.ConclusionsThe WeChat-based self-administered method can be used for future data collection of infant and young child feeding information in China. Most of the questions and key indicators showed very good agreement without statistical differences between the two methods.

Association between Mother's Education and Infant and Young Child Feeding Practices in South Asia.

The association between mother’s education and the World Health Organization’s (WHO’s) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother’s education and the WHO’s eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)—Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother’s education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.

Type of terrain and infant and young child feeding practices: cross-sectional study findings on children below 2 years of age from northern Bangladesh

IntroductionOptimal feeding practices are vital for the subsistence, adequate nutrition, physical growth and mental development of infants and young children. This study aimed to examine the prevalence of core infant...

Feeding Pattern and Nutritional Status of Under Two Years of Children in Climate-vulnerable Southern Barisal and Khulna Region of Bangladesh

Globally, undernutrition is responsible for almost half of all infant deaths. Recommended infant and young child feeding (IYCF) practices have been considered to be protective against undernutrition. The objective of the study was to assess the pattern of IYCF practices as well as the nutritional status of children 0-23 months in Barishal and Khulna region of Bangladesh. To assess the current feeding practices and factors associated with nutritional status, the present study used secondary data from a baseline survey of the project titled, "Integrated Agriculture and Health-based Interventions for Improved Food and Nutrition Security in Selected Districts of Southern Bangladesh". Socio-demographic, anthropometric and IYCF indicators were analyzed. The results showed that 30.6% of children met minimum dietary diversity (MDD) whereas 76.2% of children attained minimum meal frequency (MMF) and 29.1% of children had minimum acceptable diet (MAD) subsequently. The prevalence of stunting, wasting and underweight was 27.1%, 8.9%and 20.1%, respectively. All indicators of the IYCF were significantly associated with age and MAD was statistically significant with the children's household wealth index and sex. There was a high prevalence of underweight among children who did not receive MDD (25.4%), MMF (26.5%), or (MAD) (25.3%), compared to children who received MDD (20.6%), MMF (22.9%), or MAD (20%). In comparison with national data, IYCF practices in Barishal districts are better than those in Khulna districts, but still fall below the national target of 34% by 2025. Therefore, to optimize the IYCF practices among the children extensive programmes and research work are required. Bangladesh J. Nutr. Vol. 33, December 2020, P: 73-85

Breastfeeding and complementary feeding practices in Mexico: results from Ensanut 2018-19

To update the prevalence of infant and young child feeding indicators (IYCFI) in children under 24 months in Mexico. Ensanut 2018-19 national representative survey with probabilistic design. Popu-lation: Women 12-59 years and their children <24 months. The indicators proposed by the World Health Organization were assessed by sociodemographic variables of the mothers using the sample design. Wald's test was used to compare between categories. The prevalence of exclusive breastfeeding in children under six months was 28.3%, 42.9% of children under 12 months consumed infant formula and 29% continued breastfeeding at two years. Around 30% of children between 6 and 11 months did not meet the recom-mended minimum dietary diversity and only 49.4% consumed iron-rich foods. There are improvements in breastfeeding practices in Mexico, although the figures are low. The coordinated contribution from all sectors of society is required to improve infant feeding practices.

Maternal Knowledge, Attitudes, and Practices of Complementary Feeding and Child Undernutrition in the Vakinankaratra Region of Madagascar: A Mixed-Methods Study.

ABSTRACTBackgroundData are limited on how feeding knowledge and practices relate to child undernutrition in the highlands of Madagascar.ObjectivesThis study assessed maternal knowledge and practices of complementary feeding and their associations with anthropometrics of children aged 6–23 mo in the Vakinankaratra region of Madagascar.MethodsKnowledge was assessed using WHO recommendations on child feeding, and WHO infant and young child feeding (IYCF) indicators were used to evaluate feeding practices. Child growth was measured as length-for-age, weight-for-age, and weight-for-length z-scores using the 2006 WHO growth standards. A z-score less than −2 was classified as child undernutrition. Logistic regression models were used to determine associations between independent variables and outcomes. Focus group discussions among mothers and in-depth interviews with key informants were conducted; barriers and facilitators of optimal feeding practices were identified using a thematic analysis approach.ResultsMaternal knowledge scores regarding child feeding averaged 6.4 of 11. Better knowledge scores were associated with higher odds of appropriate complementary feeding practices before and after covariate adjustments. The proportions of children achieving the minimum dietary diversity (35.8%), minimum acceptable diet (30.2%), and consuming meat, fish, and poultry (14.1%) were low. Only consumption of iron-rich foods was associated with lower odds of underweight (adjusted OR = 0.3; 95% CI: 0.1, 0.7; P < 0.05). None of the IYCF indicators were associated significantly with stunting or wasting. Maternal attitudes about complementary foods, as well as mothers’ workload and very low income, were identified as barriers to optimal feeding practices. Maternal perceived benefits of giving appropriate complementary foods as well as their positive relationship with the community health workers were the main facilitators of optimal child feeding.ConclusionsIntegrated nutrition-sensitive interventions addressing these barriers while enhancing the facilitators are critical in promoting better feeding practices in the Vakinankaratra region.