Optimal Complementary Feeding Practices 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.

Patterns of complementary feeding introduction and associated factors in a cohort of Brazilian infants

BackgroundUnderstanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants.MethodsData were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant’s first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction.ResultsThree distinct patterns were identified and named according to their main characteristics: Pattern 1 – “Low Infant Formula and Timely CF Introduction”; Pattern 2 – “High Infant Formula and Early CF Introduction”; and Pattern 3 – “High Infant Formula and Later Ultra-processed Food Introduction”. Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10–1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53–0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13–2.01) or > 34 years (PR = 1.42; 95% CI = 1.04–1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01–1.80).ConclusionsWe identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.

Dietary diversity and associated factors among infants and young children in three West African countries.

Providing children healthy diversified diets is important for their optimal growth and development. The high prevalence of under-nourishment during the critical early life period is of serious concern in West Africa. We assessed the level of dietary diversity and associated factors for children aged 6-23 months in Côte d'Ivoire, Niger and Senegal. Prior 24 h dietary intake was assessed for 3,528 children (Côte d'Ivoire: N = 118; Niger: N = 763; Senegal: N = 2,647) using the Diet Quality Questionnaire survey tool administered to primary caregivers. Cluster random sampling was conducted for urban and rural areas in Niger and Senegal and simple random sampling was used in Côte d'Ivoire, where only rural households were selected. Survey data were analyzed to determine children's intake of items from eight food groups: breast milk; grains, roots, tubers and plantains; pulses, nuts and seeds; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum Dietary Diversity (MDD) was assessed based on the consumption of ≥5 of the 8 food groups. In all countries, the majority of children were ≥ 12 months of age and from rural households. Children from poor/very poor households ranged from 32.4 to 41.9%. MDD prevalence was 54.2% in Côte d'Ivoire, 33.3% in Niger and 30.8% in Senegal. In all three countries, children 12-23 months had significantly higher consumption of six of the food groups, compared to those 6-11 months, and children ≥12 months had a higher likelihood of MDD, compared to infants, in Niger (aOR = 4.25; 95% CI: 2.46, 7.36) and Senegal (aOR = 2.69; 95% CI: 2.15, 3.35). MDD prevalence was higher among children in urban, compared to rural, areas in Niger (p = 0.020) and Senegal (p < 0.001) and significantly higher in the wealthiest, compared to poorest, households. This study suggests most young children in Côte d'Ivoire, Niger and Senegal are not receiving an adequately diversified diet, with a reliance on starchy staples and lower intake of high-quality protein sources. Our results highlight socio-economic barriers to attaining dietary diversity in these settings and stress the urgent and continuing need for investments in strategies that support optimal complementary feeding practices.

Optimal complementary feeding practices of children aged 6-23 months in three agro-ecological rural districts of Jimma zones of southwest Ethiopia.

Despite the critical importance of complementary feeding, large proportions of children in developing countries are sub-optimally fed during 6-23 months of age. In Ethiopia, even though the government has been rolling out infant and young child feeding (IYCF) guidelines, the proportion of mothers adhering to the recommended optimal practices and its associated factors have not been assessed in different agro-ecological areas. Hence, the present study aimed to determine optimal complementary feeding practices and associated factors in three agro-ecological rural districts (high, mid and lowland) of southwest Ethiopia. A community-based cross-sectional study was carried out among 845 mothers-index young children 6-23 months Jimma zone. Multistage sampling was employed to select the study participants. Structured and pretested questionnaires were used to collect data and entered into Epi Data V.1.4.4.0. The data were analysed using SPSS version 20. Binary and multivariable logistic regressions were used to identify factors associated with optimal child-feeding practices. The significance of the association was determined at P < 0⋅05. The overall proportion of optimal complementary feeding practice (OCFP) was 9⋅4 % at 95 % CI (7⋅19, 11⋅08). The timely initiation of complementary feeding, minimum meal frequency, minimum dietary diversity and minimum acceptable diet was 52⋅2, 64⋅1, 17⋅2 and 12⋅2 %. Multivariable logistic regression showed that being in the highland districts, having good maternal knowledge, and mothers having primary school education, having a family size of less than six were positively associated with optimal complementary feeding practices. The findings showed that OCFP was low, especially in the midland agro-ecological districts.

Optimal complementary feeding practices and associated factors among mothers having children 6 to 23 months, south WOLLO zone, Dessie ZURIA, Ethiopia

IntroductionOptimal complementary feeding practice is a child feeding practice that fulfills the minimum dietary diversity, the minimum meal frequency, continuing breastfeeding with complementary feeding, and initiation of complementary feeding from 6 to 8 months. MethodA community-based comparative cross-sectional study was conducted on a total of 732 randomly selected mothers having children 6 to 23 months of age from March 10 to April 21 /2021.Data were collected using a pre-tested interviewer-administered questionnaire. Data entry was performed by using Epi data version 3.1 and was exported to Stata version 14.1. Descriptive statistics were done. Multivariable Logistic regression was used to predict the role of independent variables on optimal complementary feeding. Findings with a p-value <0.05 at a 95% confidence interval (CI) were considered statistically significant in the final model. ResultThe overall proportion of mothers with optimal complementary feeding practice was 18.1% (95% C I 15.3% – 21.0). Only 90 (25.1%, 95% CI = 20.6–29.7) of mothers were found to have optimal complementary feeding practice in NGO supported kebeles but only 37 (10.8%, 95% CI = 7.5–14.1) practiced optimal complementary feeding is not NGO-supported kebeles. Mothers from Kebeles with no NGO support were 46% (AOR = 0.54, 95% CI 0.31, 0.96) less likely to practice optimal complementary feeding. On the other hand, mothers of children aged20–23 months were four times (AOR = 4.47, 95% CI 2.02–9.91) more likely to practice optimal complementary feeding than mothers having children 6–8 months of age. Practice implicationsDifferent interventions have been implemented by governmental and non-governmental organizations to improve this condition in Dessie Zuria District. But, there is limited data on the extent to which intervention by governmental and non-governmental organizations reduces this improving condition. The aim of this study was to assess the Optimal Complementary Feeding Practice and Associated Factors among Mothers Having Children Aged 6–23 Months, Ethiopia 2021. ConclusionOptimal complementary feeding practices among mothers in NGO-supported kebeles were higher than not supported kebeles. Therefore, strengthening and scaling up the program to not-supported kebeles is recommended to improve the optimal complementary feeding practiced.

Optimal complementary feeding practices among caregivers and their children aged 6–23 months in Kisoro district, Uganda

BackgroundThere are many risk factors for stunting, and studies most often corroborate complementary feeding practices as a significant risk factor. Information on the prevalence of optimal complementary feeding practices and factors that lend to caregivers meeting their requirements in Kisoro district, a district with high stunting rates, is mostly lacking.MethodologyAn analytical cross-sectional study that used secondary data from a USAID-funded project. Entries for 384 caregivers of children aged 6–23 months in Kisoro district were abstracted from the project database. The data was analysed using SPSS version 20. The association between independent factors and optimal complementary feeding practices was determined using multivariable logistic regressions at the three levels of the Socio-Ecological Model.FindingsAlthough 95% of the infants were introduced to semi-solid foods promptly, their diet was nutritionally inadequate as evidenced by the low minimum dietary diversity of 4.43%. Some of the key covariates associated with these outcomes included, the type of occupation (AOR = 21.21; CI = 2.03—221.26; p = 0.011), community groups (AOR = 0. 43; CI = 0.22—0.83; p = 0.012), not being married (AOR = 13.25; CI = 1.76—100.25; p = 0.012), age of the child (AOR = 2.21; CI = 1.1—4.45; p = 0.026); among others.ConclusionThe prevalence of MAD and MDD was very low in Kisoro district, even compared to national figures, putting these children at a very high risk of stunting. Increased advocacy is needed to support the community-level implementation of the IYCF guidelines.

Fathers’ Complementary Feeding Support Moderates the Association Between Mothers’ Autonomous Household Decision-Making and Optimal Complementary Feeding

ObjectivesThe evidence base on the role of maternal decision-making autonomy in optimal complementary feeding practices is not consistent, leaving questions about moderation by social support. The objective of this research is to examine the moderation effect of fathers’ complementary feeding support on the association of maternal decision-making autonomy with complementary feeding indicators. MethodsWe used logistic regression interaction models to examine whether complementary feeding support was a moderator of the association between decision-making autonomy and complementary feeding using data from endline (cross-sectional) surveys administered to 495 cohabiting mothers and fathers of children aged 6–23 months in Igabi local government area (LGA), Kaduna State, Nigeria. The 12-month Alive & Thrive intervention engaged fathers through complementary feeding messages from religious and community leaders, text, and voice messages. Mothers received home visits and feeding bowls from community health extension workers (CHEWs). The intervention also included mass media messaging on radio and TV. ResultsMaternal decision-making autonomy was associated with minimum dietary diversity (AOR, 1.15; 95% CI, 1.00, 1.32), minimum meal frequency (AOR, 1.31; 95% CI, 1.11, 1.53), minimum acceptable diet (AOR, 1.24; 95% CI, 1.09, 1.41) and feeding children fish (AOR, 1.23; 95% CI, 1.08, 1.40). Complementary feeding support was associated with minimum dietary diversity (AOR, 1.38; 95% CI, 1.08, 1.75), minimum meal frequency (AOR, 1.34; 95% CI, 1.05, 1.70), minimum acceptable diet (AOR, 1.40; 95% CI, 1.14, 1.73), feeding eggs (AOR, 1.49; 95% CI, 1.16, 1.90) and feeding fish (AOR, 1.30; 95% CI, 1.06, 1.60). In the interaction models, the simple slopes for decision-making were significant for most of the complementary feeding indicators when fathers offered > 2 types of support. ConclusionsWithin the context of Kaduna, high levels of fathers’ complementary feeding support strengthen the association of maternal decision-making autonomy with complementary feeding practices. Funding SourcesThis research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation, Irish Aid, and other donors.

Male Partner Involvement in Complementary Feeding Practices Among Households With Children Aged 6–24 Months in Abim District, Uganda

ObjectivesGeneral Objective: To determine the level of male partner involvement in complementary feeding practices and associated factors among households with children aged 6–24 months in Abim District so as to devise most effective strategies, approaches and interventions for encouraging male partner involvement with a view of improving adoption of optimal complementary feeding practices in children aged 6–24 months. Research Questions - What is the level of male partner involvement in complementary feeding practices among households with children aged 6–24 months? - What factors are associated with male partner involvement in complementary feeding practices among households with children aged 6–24 months? MethodsA cross-sectional study involving both quantitative (382 mothers) and qualitative (2 FGDs and 2 KIIs) approaches was conducted. Data entry was done and checked for completeness and consistency using Epi Data 3.0. Data analysis was done using SPSS version 20. Descriptive statistics were used to define the characteristics of study participants. At bivariate analysis, Pearson’s chi square tests were used to establish the association between the dependent and each independent variable. At multivariate analysis, a binary logistic regression was executed to establish factors associated with male partner involvement in complementary feeding using odds ratios. Strength of association was determined at 5% level of significance (p < 0.05). ResultsThe level of male partner involvement in complementary feeding in this study was good (68%). It was associated with; tertiary education of mother (OR = 1.38, CI 95% = 0.01 to 0.08; p = 0.00), mothers in formal employment (OR = 1.03; CI 95% = 1.001 t0 3.05: p = 0.001), husbands in formal employment (OR = 1.75; CI 95%: 1.05 to 2.89; p = 0.021) and husbands aged between 25–29 years (OR = 3.73; CI 95% = 1.96 to 7.07; p = 0.002). ConclusionsMale partner involvement in complementary feeding in Abim district is good. It is associated with; formal employment for mothers and their partners, mothers with tertiary education, and husbands aged between 25–29 years. The government needs to strengthen multi-sectoral integration to address the gender gaps and barriers that hinder male partner involvement in the broader infant and young child feeding practices. Funding SourcesNone.

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

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

Complementary feeding practices and associated factors among children aged 6-23 months in rural Haramaya district, Eastern Ethiopia: A community-based cross-sectional study.

Background: The age of children up to 59 months is a critical period for children's growth and development and the age when optimal complementary feeding is crucial. Aim: To assess optimal complementary feeding practices and associated factors among children aged 6-23 months in rural Haramaya district, Eastern Ethiopia. Methods: A community-based cross-sectional study was conducted. Statistical Package for Social Science (SPSS) version 24 was used for the analyses. Bivariable and multivariable logistic regression analysis were conducted at p-value < 0.05 and an Adjusted Odd Ratio (AOR) with a 95% Confidence Interval (CI). Results: The percentage of mothers that practiced optimal complementary feeding practices was 53.5% (95% CI: 49.2%, 57.6%). Average monthly income of the family, $37.5 to $75 (AOR = 0.52, 95% CI: 0.28, 0.98), institutional delivery (AOR = 1.61, 95% CI: 1.06, 2.46), postnatal care follow-up (AOR = 2.53, 95% CI: 1.67, 3.82), having an awareness about IYCF (AOR = 3.05, 95% CI: 1.85, 5.02), less than 30 min foot-walking to reach health facility (AOR = 2.61,95% CI: 1.65, 4.09), separate child's feeding plate (AOR = 1.75, 95% CI: 1.16, 2.64), and attendance of Infant and Young Child Feeding demonstration (AOR = 2.02, 95% CI: 1.33, 3.07) were significantly associated with optimal complementary feeding practices. Conclusion: The magnitude of optimal complementary feeding practices was below the minimum recommended level for the growth and development of children in the study area. Lack of access to and underutilization of maternal and child healthcare services were significant risk factors for suboptimal complementary feeding practices. Maternal and child health services would be essential to mitigate suboptimal feeding practices for children aged 6-23 months.

Meat Helps Make Every Bite Count

New evidence-based dietary guidelines for feeding infants from birth to 24 months old recommend meat as an ideal first complementary food. Starting at 6 months old, infants need a variety of nutrient-dense foods, including foods that are rich in bioavailable iron and zinc. Because infants and toddlers eat small quantities of foods, it is critical to make every bite count in the early years. New parents are often unsure of optimal complementary feeding practices. The goal of this article is to review the role of red meat as a potential first complementary food for infants.

Evaluating the pathways linking complementary feeding practices to obesity in early life.

The complementary feeding period, when solids and liquids other than breast milk and formula are added to the infant diet, is an important development window shaping infant growth and weight gain, metabolic development, and lifelong eating practices. Yet, relatively little is known about how the timing and types of foods offered to infants at this stage may shape their growth and subsequent risk of developing obesity. This narrative review describes the existing literature on complementary feeding practices, discusses potential biological and behavioral pathways linking complementary feeding practices to the development of obesity, and offers potential avenues for intervention. While further research is needed to more fully understand optimal complementary feeding practices, existing evidence supports the importance of healthful early feeding practices in the physiological and behavioral regulation of growth and metabolism and the need for early intervention to prevent the development of obesity.

Using formative research to design context-specific animal source food and multiple micronutrient powder interventions to improve the consumption of micronutrients by infants and young children in Tanzania, Kenya, Bangladesh and Pakistan.

Optimal complementary feeding practices including consumption of multiple micronutrient powders (MNP) are recommended to improve micronutrient intake by infants and young children (IYC) 6–23 months. Formative research was used to design the behaviour change strategy to improve IYC micronutrient intake for the multicountry ENRICH project in rural impoverished areas of Tanzania, Kenya, Bangladesh and Pakistan. Employing a qualitative approach with multiple methods and guided by a social ecological framework, the study was conducted in several phases: data collection in the community, household and health facilities, initial analysis and household trials (HHT). Results found limited use of animal source foods (ASF) for feeding IYC and MNP largely unavailable. Although cost constrained access to ASF, potential more affordable context‐specific ASF options were identified in each setting. Caregivers associated ASF with many positive attributes for IYC, but barriers to feeding them included lack of caregiver time and knowledge of specific preparation techniques, and limited advice from health workers. Feeding practices were identified that used time‐efficient, specific preparations for eggs and other ASF, and demonstrated good initial acceptability and feasibility during HHT. Testing MNP in HHT found good initial feasibility and acceptability and provided an understanding of the facilitators and constraints for preparing, feeding and promoting MNP. In conclusion, formative research led to the design of context‐specific ASF and MNP complementary feeding promotion strategies to improve IYC consumption of micronutrients by identifying the practices, benefits, motivations and alternative actions to overcome the barriers in each setting.

Complementary feeding practices and nutritional status of young children in a community in Sokoto

Background: Complementary feeding is the cornerstone of child’s nutrition. Most malnourished children had their predicament originating from the period of transition from breastfeeding to family diet.&#x0D; Objectives: To determine the complementary feeding practices and nutritional status of young children in Gwiwa community.&#x0D; Materials and Methods: This cross-sectional study was carried out in Gwiwa community, Wammakko LGA, Sokoto State between January and June, 2018. Three hundred and ten mothers with their children aged 6 –36 months were interviewed using structured interviewer - administered questionnaire and the children’s nutritional status was assessed using WHO classification of malnutrition. Data was analysed using SPSS version22.0.A p-value ≤0.05 was taken as significan.&#x0D; Results: One hundred and forty (45.2%) respondents were aged 15 – 24years and 168(54.2%) were of low socio-economic class. There were 190 males and 120 females with 66 (21.3%) children exclusively bre as t - fed for 6months. The mean age of cessation of breast feeding was 17.8 ±3.6 months. One hundred and sixty-nine (54.5%) children commenced complementary feeding at 6-8month of age with the mean age of 5.7(±2.6) months. One hundred and eighty-four (59.4%) used plain pap with 41.2% fed more than 3 times per day. Eighty-two (26.5%), 56(18.1%) and 76 (24.5%) children were underweight, wasted and stunted respectively.&#x0D; Conclusion: The complementary feeding practices were suboptimal in this community and might explain the poor nutritional status of their under- fives. Efforts should be geared towards optimal complementary feeding practices in this community.&#x0D; Key words: Complementary, Feeding, Practice, Nutritional, Status, Under-5.

Determinants and Current Level of Optimal Complementary Feeding Practices among Lactating Mothers of Children in Ambo Town, Oromia, Ethiopia

An appropriate diet is critical in the growth and development of children especially in the first two years of life. Poor complementary feeding of children aged 6 months - 23 months contributes to the characteristics negative growth trends and deaths observed in developing countries. Therefore, this study aimed to assess determinants and current level of optimal complementary feeding practices among mothers of children aged 6 months to 23 months in Ambo town, Oromia Region. The study used cross sectional study design and targeted 336 mothers with children 6 months - 23 months olds. Information from the respondents were collected using standard questionnaire. Data entry and analysis was done using SPSS version 21.0 windows statistical software. All (100%) the children 6 months - 8 months old had received solid, semi-solid/soft foods. The minimum meal frequency was attained by 88.3% (95% CI 84.3-91.4) whereas the minimum dietary diversity was attained by 17.9% (95% CI 14.1-22.5). The minimum acceptable diet was attained by 15.4% (95% CI 11.9-19.8). Maternal knowledge on: importance of breastfeeding (87.3%); age of introduction of complementary foods (85.4%) and correct meal frequency for age (74.5%) was high. On the contrary, knowledge on the importance of enriching complementary foods (34.5%) was low. Mothers who knew the importance of a diverse diet were likely (chi-square test; p=0.001) to feed their children on a diverse diet. On the other hand, mothers who knew the importance of enriching complementary foods were likely to feed their children on a minimum acceptable diet (chi-square test; p = 0.007) and maternal knowledge on enriching complementary foods (OR = 3.41, p = 0.040) were significant predictors of consumption of Vitamin A rich foods, minimum meal frequency and minimum acceptable diet, respectively. Behaviour change and communication involving all the stakeholders in infant and young child feeding should be emphasized. Messages on appropriate feeding practices should include importance of dietary diversity

Minimum Diet Diversity and Minimum Meal Frequency – Do They Matter Equally? Understanding IYCF Practices in India

Abstract Objectives Infant and Young Child Feeding practices, mainly, complementary feeding in children between 6 months and two years of age, is found to be sub-optimal and emerge as the weakest link in improving child nutrition outcomes in India. Minimum Acceptable Diet (MAD), comprising of two sub-indicator – Minimum Dietary Diversity (MDD) and Minimum Meal Frequency (MMF), serves as an essential indicator to understand the diet adequacy pattern in children. The objective of this study was thus to investigate the role of MDD-MMF dyad in influencing the nutritional outcomes in children and its pattern across regions in India. Methods Data was obtained from the National Family Health Survey – 4 (NFHS-4) from the DHS Program website. The prevalence of MMF and MDD was calculated for 640 districts in India. The MMF and MDD were classified into three categories - high, medium and low based on equal percentile distribution of their prevalence range. Districts with high MMF and high MDD formed one cohort. Similarly, eight other cohorts were created based on their performance on MMF and MDD indicator. The prevalence of Stunting (St), Wasting (Wa) and Underweight (Uw) in children between 6 months and two years of age was then calculated for each of the nine cohorts. The districts were also mapped based on their cohort category to study the variation across regions in India. Results All three anthropometric indicators – stunting, wasting and underweight showed significant decline moving across low MMF- low MDD cohort (40% St; 26.2% Wa; 37.1% Uw) to medium MMF – medium MDD cohort (38.6% St; 23.8% Wa; 35.4% Uw) to high MMF – high MDD cohort (29% St; 15.5% Wa; 19.2% Uw). Second, the importance of minimum dietary diversity in improving nutritional outcomes was revealed, as opposed to minimum meal frequency, which shows improvement only when it reaches a certain threshold. Third, mapping revealed sharp differences across various regions in MMF-MDD pattern, especially in the states like Odisha, Assam and Andhra Pradesh. States in the central region performed poorly on complementary feeding indicators, specifically diet diversity. Conclusions The study highlights the importance of optimal complementary feeding practices in improving nutrition outcomes and the need to consider the regional heterogeneities while promoting IYCF practices in India. Funding Sources None.

Maternal socio-demographic characteristics and associated complementary feeding practices of children aged 6-18months with moderate acute malnutrition in Arua, Uganda.

There is a paucity of published data regarding maternal socio-demographic characteristics and associated complementary feeding practices of moderately malnourished infants and young children (IYC) in sub-Saharan Africa. In the present study, this association was investigated in Arua, Uganda. A cross-sectional baseline survey was conducted among 204 conveniently sampled mothers of IYC aged 6-18months with moderate acute malnutrition earmarked for dietary supplementation in four randomly selected sub-counties to determine their socio-demographic characteristics using a validated questionnaire. A 24-h recall was used to evaluate complementary feeding practices in terms of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Associations were determined using multivariate logistic regression analysis. The majority (70.1%) of mothers had a primary school education, with 15% having no formal education. Foods especially purchased or prepared for IYC were provided by 42.6% of the mothers. The MDD and MMF of IYC were 13.2% and 41.2%, respectively. MMF and MDD for MAD were met by 6.9% of IYC. Maternal level of education and MMF was significantly associated (P=0.003), whereas the provision of foods especially purchased or prepared for IYC was significantly associated with MMF (P=0.003). Maternal care was significantly associated with MAD (P=0.004). Optimal complementary feeding practices were not met by the majority of mothers. Maternal level of education and care of IYC were strong predictors of MMF. Nutrition education and care should be promoted among mothers of IYC with moderate acute malnutrition to improve MDD, MMF and MAD.

Accelerating progress for complementary feeding in Kenya: Key government actions and the way forward.

Optimal complementary feeding practices, a critical component of infant and young child feeding, has been demonstrated to prevent micronutrient deficiencies, stunting, overweight, and obesity. In Kenya, while impressive gains have been made in exclusive breastfeeding, progress in complementary feeding has been slow, and the country has failed to meet targets. Recent 2014 Kenya Demographic and Health Survey reveal that only 22% of Kenyan children, 6–23 months, met criteria for a minimum acceptable diet. This case study describes key actions for complementary feeding put in place by the Kenya Ministry of Health as well as approaches for improving and monitoring complementary feeding within existing health platforms. Experience from USAID's Maternal and Child Survival Program and Ministry of Health on development of 23 complementary feeding recipes through application of a national guide for recipe development and Trials of Improved Practices is described. Challenges in how to prepare, modify, and cook foods, including meat, for young children 6–23 months of age was relayed by mothers. Addressing cultural beliefs around complementary feeding meant providing reassurance to mothers that young children are developmentally able to digest fruit and vegetables and ready to consume animal‐source protein. Through the Baby Friendly Community Initiative platform, cooking demonstrations and key hygiene actions were integrated with complementary feeding messages. Future programming for complementary feeding should consider development of context specific counselling messages on consumption of animal source foods, strengthen production and use of local foods through agriculture‐nutrition linkages, and include complementary indicators through routine health monitoring systems to track progress.

Feeding practices according to the WHO- recommendations for HIV exposed children in northwest Ethiopia: A cross-sectional study

Malnutrition is a major problem for HIV exposed children, which is mainly caused by inappropriate feeding practice. Hence, the study aimed to assess adherence to optimal complementary feeding practices recommended by the WHO and associated factors among HIV exposed infants and young children aged 6-18 months in selected Amhara Regional Hospitals, northwest Ethiopia. An institution based cross-sectional study was conducted from March 10 to April 30, 2017. Systematic random sampling was employed to select study participants. A 24hr dietary recall was used to assess compliance with child optimal complementary feeding practice. Children were considered to have received optimal complementary feeding when they fulfill the criteria of the timely introduction of solid, semi-solid or soft foods, and minimum acceptable diet. Both bi-variable and multivariable binary logistic regression analysis were applied to identify factors associated with optimal complementary feeding practice. In this study, about 25.5% of HIV exposed children received optimal complementary feeding. More than two thirds, (70.7%), and more than a third, (36.9%), of the children received the recommended meal frequency and minimum acceptable diet, respectively. Father's education; primary (AOR=2.39; 95%CI: 1.18, 4.88) and higher (AOR=2.44; 95%CI: 1.37, 4.34), rich household wealth status (AOR=2.08; 95%CI: 1.13, 3.82), and satisfactory media exposure (AOR=1.70; 95%CI: 1.04, 2.78), and mothers disclosing that they have HIV (AOR=1.78; 95%CI: 1.07, 2.98) were positively associated with optimal feeding practices. Optimal complementary feeding practice was not at the level recommended by the WHO. Household wealth status, mother's HIV disclosure, and paternal educational status were positively associated with optimal complementary feeding practices among HIV exposed children. Therefore, a social safety net program for HIV positive mothers is recommended. In addition, strengthening maternal counseling about disclosure of HIV status and increased media promotion of optimal child feeding is important to achieve the recommended feeding goals.

Breastfeeding and complementary feeding practices among children living in a rice surplus area, Central Java, Indonesia

PurposeThis paper aims to investigate breastfeeding and complementary feeding practices among children less than five years old and living in a rice surplus area in Demak Regency, Central Java.Design/methodology/approachFrom December 2014 to February 2015, a cross-sectional survey was carried out in Demak, which had a high proportion of undernourished children despite high rice production. In total, 384 mothers having children below five years old from farmer family background were interviewed using a structured questionnaire about sociodemographic parameters and child feeding practices. Food habits were also investigated among these women during two focus group discussions in two selected sub-districts.FindingsOnly 10.9 per cent of the children were exclusively breastfed for six months. About 60 per cent of the mothers practiced supplementary feeding in addition to breastfeeding and started complementary feeding too early. Duration of exclusive breastfeeding practice and child’s age at onset of complementary feeding were positively correlated (p = 0.04). The main reasons of supplementary feeding and too early introduction of complementary food were based on the elderly women’s opinions, and the very short duration of maternity leave for employed mothers. Mothers with a low education level had a higher chance of not reaching the optimum score of complementary feeding practices (p = 0.012).Originality/valueDespite a high level of food security in the project area, inadequate knowledge of young child feeding practices has contributed to sub-optimal breastfeeding practices. Higher educated women were more likely to follow optimal complementary feeding practices. Therefore, promotion of breastfeeding and complementary feeding practices targeting all key actors should be implemented in the study area to prevent undernutrition among infants.