Young Child Feeding Indicators Research Articles

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.

Estimating minimum dietary diversity for children aged 6-23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia.

To compare the agreement and cost of two recall methods for estimating children's minimum dietary diversity (MDD). We assessed child's dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods. Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts). Children aged 6-23 months: 636 in Cambodia and 608 in Zambia. MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries. The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.

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.

A cross-sectional study of feeding practice status in children (6–23 months), association with malnutrition, and impacts of maternal determinants

Background: Inadequate complementary feeding practices lead to poor cognition, stunting, and increased rate of infections. Insight into deficiencies of complementary feeding practices could help in planning and implementing newer approaches at various levels of intersection. Aims and Objectives: The aim and purpose of the study were to determine the complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between complementary feeding practices with malnutrition. Materials and Methods: A prospective observational study was conducted at the Department of Pediatrics, of a tertiary hospital over a 14-week period. All children aged 6–23 months were included in the study. Data were collected using a pre-structured questionnaire based on the World Health Organization Infant and Young Child Feeding (IYCF) indicators for assessing IYCF practices. Results: A total of 400 mothers participated in the study. The mean age of children was 12.58 20±5.02 months, male: female = 1.6:1. The mean age of starting complementary feeding was 6.81±1.79 months. Semisolid food was introduced in 90.2% of children, minimum dietary diversity was received by 61.0%, minimum meal frequency by 83.8%, and minimum acceptable diet by 58.2%, eggs and flesh by 14.2% and 3.5% children, respectively; only 9.2% received vitamin A rich fruits and 38.5% did not receive any vegetable or fruit. Bottle feeding was present in 55.5% of population. Maternal parameters (education, employment access to media) and socioeconomic status were significantly associated with feeding practices (P<0.05). A significant difference was found in the nutritional status (wasting and stunting) of children who did not receive minimum dietary diversity (P<0.01). Conclusion: Wide gap exists in feeding practices even in urban settings and was significantly associated with child’s nutritional status.

Association between infant and young child feeding indicators and the nutritional status of children aged 6-23 months in rural areas of Hunan Province in 2019

To estimate the status of complementary feeding among infants and young children aged 6-23 months in rural areas of Hunan Province. The association between infant and young child feeding indicators and child undernutrition were assessed. A total of 1220 infants and young children aged 6-23 months from 24 investigated places of 6 cities in Hunan Province were selected by multi-stage stratified sampling for physical measurement, hemoglobin(Hb) test and caregiver interview. Complementary diet was analyzed according to the World Health Organization's definition of infant and young child feeding indicators. Z-scores were used to elevate nutrition status. Logistic regression models were used to explore the influencing factors of the nutritional status. The prevalence rates of underweight, stunting, wasting, overweight, obesity and anemia were 3.6%, 4.8%, 2.7%, 10.5%, 2.0% and 16.3%. The percentage of infants and young children aged 6-23 months in rural areas of Hunan Province who get minimum dietary diversity, minimum meal frequency, and minimum acceptable diet was 43.3%, 68.5% and 28.1%. None of the individual infant and young child feeding indicators showed significant association with undernutrition, except minimum meal frequency for obesity and anemia. The nutritional status of infants and young children in rural areas of Hunan Province has improved, but the anemia problem is still serious. Complementary feeding frequency is closely associated with anemia for infants and young children.

Changes of sweet beverage and unhealthy food consumption among infant and young child aged 6-24 months old in China

To describe the change of sweet beverage and unhealthy food consumption among infant and young child aged 6-23 months in 2013, 2016-2017, China. Data was from the China Nutrition and Health Surveillance among Children and Lactating Women in 2013, 2016-2017.9983, 20 423 children aged 6-23 months old were involved respectively. The sweet beverage and unhealthy food consumption was analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference. The proportions of sweet beverage consumption among children aged 6-23 months was 20.2%(95%CI 16.0%-24.4%) in 2013; it was 29.6% in large cities, and 14.0% in poor rural areas, but there was no significant difference in different areas. Compared with 2013, the proportions of sweet beverage consumption increased significantly in 2016-2017, reaching 51.7%(95%CI 48.9%-54.4%); it was 54.1% in medium and small cities, and 44.3% in large cities. The proportions of unhealthy food consumption among children aged 6-23 months was 31.2%(95%CI 23.2%-39.3%) in 2013; it was 46.3% in medium and small cities, and 16.3% in poor rural areas. Compared with 2013, the proportions of unhealthy food consumption was 35.6%(95%CI 33.6%-39.3%) in 2016-2017, and no significant difference was observed(Rao-Scott χ~2=0.96, P=0.33); It was 38.6% in medium and small cities, and reached 30% in large cities and poor rural areas. For those 2 indicators at the same survey, no consistent differences were observed between boys and girls and there was significant difference in various months of age(P<0.01). In China, the proportion of sweet beverage consumption among children aged 6-23 months has increased significantly, and the intake of unhealthy food is relatively stable. Children aged over 12 months and in rural areas need to be concerned about.

Infant and young child feeding indicators are positively associated with length and family care indicators in the children of the Women First trial participants.

This research describes the proportion of children in four low- and middle-income countries with adequate dietary practices at 6, 12, 18 and 24 months of age and how these practices changed over time using the World Health Organisation and UNICEF's infant young child feeding (IYCF) indicators. The associations between the IYCF indicators and anthropometric z-scores from 6 to 24 months, and between the IYCF indicators and the family care indicators (FCIs) at 24 months are described. This was a longitudinal study of offspring from participants in the Women First Preconception Maternal Nutrition Trial conducted in Sud-Ubangi, Democratic Republic of Congo; Chimaltenango, Guatemala; Belagavi, North Karnataka, India; and Thatta, Sindh Province, Pakistan. The frequency of the minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum adequate diet (MAD) increased between 6 and 24 months, but even at 24 months MAD remained below 50% at all sites. MDD (β = 0.12; 95% CI = 0.04-0.22) and MMF (β = 0.10; 95% CI = 0.03-0.17) were positively associated with length-for-age z-score at 24 months. All IYCF indicators were positively associated with mean total FCI score: MDD (proportion ratio [PR] = 1.04; 95% CI = 1.02-1.07), MMF (PR = 1.02; 95% CI = 1.01-1.04), MAD (PR = 1.05; 95% CI = 1.02-1.08). Although there are multiple barriers to young children having an adequate diet, our results support a positive association between familial interactions and improved IYCF feeding practices.

Status of infant and young child feeding in China in 2016-2017

To describe the feeding status and related factors of infant and young child aged 6-23 months in China. Data was from the China Nutrition and Health Surveillance among 0-17 Years Old Children and Lactating Women in 2016-2017, and 20 423 children aged 6-23 months were involved in 275 surveillance sites from 31 provinces(autonomous regions and municipalities). The introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency were analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference. The percentage of infants 6-8 months of age who consumed solid, semi-solid or soft foods was 83.2%(95%CI 80.5%-85.9%) in 2016-2017. No significant difference were observed between boys and girls; there was significant difference in different areas(Rao-Scott χ~2=30.85, P<0.01), it was 90.3% in medium and small cities, and reached 75.0% even in poor rural areas. The proportions of children aged 6-23 months meeting minimum dietary diversity(MDD) was 60.6%(95%CI 58.1%-63.1%). It was 71.1% in medium and small cities, and 50.5% in poor rural areas. Except for breast milk, the percentage of eggs(34.4%) and legumes(19.0%) consumption was low, the percentage of grains, vitamin A-rich fruits or vegetables consumption was 89.7%(95%CI 88.4%-91.1%). The percentage of consuming egg and/or flesh food was 76.4%(95%CI 74.2%-78.7%). The percentage of zero vegetables or fruits consumption was 9.1%(95%CI 7.8%-10.4%). The proportions of children aged 6-23 months meeting minimum meal frequency(MMF) was 72.4%(95%CI 70.1%-74.7%). It was over 70% in large cities, medium and small cities, general rural areas; and 60.2% in poor rural areas. The proportions of children aged 6-23 months meeting minimum acceptable diet was 43.4%(95%CI 40.7%-46.1%), it was over 50% in urban areas, and less than 40% in rural areas, 30.1% in poor rural areas. No consistent differences were observed between boys and girls for all 3 indicators(MDD, MMF and MAD), and there was significant difference in different areas and various months of age(P<0.01). There was no gender difference in the feeding status of children aged 6-23 months in China, the complementary feeding was relatively timely, and the minimum dietary diversity and meal frequency of children were relatively ideal, but the minimum acceptable diet of children in poor rural areas was poor.

High response rate and low cost of WeChat-based data collection of infant and young child feeding data in rural Qinghai Province, China.

BackgroundMeasuring the infant and young child feeding (IYCF) indicators is key to effectively tracking the progress of child health programs and making evidence-based decisions. WeChat is the most popular mobile social media platform in China and has become a promising tool for collecting health data. This study aims to explore the response rate and costs of a WeChat-based questionnaire on IYCF information in rural China.MethodsWe conducted two cross-sectional surveys with caregivers of children aged 6-23 months in two rural counties in Qinghai Province (Menyuan and Datong County), China, from January to March 2022. Both surveys used the same WeChat IYCF questionnaire to collect household information, infant feeding practices, and caregivers’ feeding knowledge. Village doctors sent a quick response (QR) code to caregivers that was linked to the WeChat IYCF questionnaire. Participating caregivers scanned the QR code using their own WeChat account on their smartphone and filled in the questionnaire online. If they could not use WeChat themselves, village doctors administered the questionnaire. Once caregivers finished the questionnaires, they received a personalized report with infant feeding recommendations.ResultsWe recruited 1274 caregivers of children aged 6-23 months in Menyuan County and 1748 caregivers in Datong County. The total response rate in the two counties was 98.2%; 77.6% of questionnaires were self-administered by caregivers and 20.6% were interviewer-administered by village doctors. The questionnaires were filled in twice by 209 (6.9%) caregivers. The cost of these two WeChat IYCF surveys was much lower than the cost of a previously conducted face-to-face survey: 11.8 yuan (US$1.85) in Menyuan County and 7.5 yuan (US$1.18) in Datong County for the WeChat survey vs 112.7 yuan (US$17.70) for the face-to-face survey in Huzhu County.ConclusionsThis study showed that using WeChat for IYCF surveys can achieve a very high response rate at a low cost in rural China. Village doctors played a very important role in achieving this high response rate. Providing feedback to caregivers may improve their feeding practices and this intervention could be incorporated into the data collection process.

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.

Impact of a Homestead Food Production Intervention on Infant and Young Child Feeding and Home Environment in Bangladesh

Abstract Objectives Optimal child growth and development depend on many factors including proper nutrition and feeding practices as well as a stimulating home environment. We aimed to assess the impact of a Homestead Food Production (HFP) program on infant and child feeding as well as child stimulation practices as part of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial in rural Bangladesh. Methods The HFP program promoted increased dietary diversity and improved child feeding practices based on the WHO's Essential Nutrition Actions, including responsive feeding and the importance of vitamin A capsules. Practices for child stimulation were not promoted although both intervention and control groups received toys (e.g., finger puppets, balls, etc.) during data collection. The 2019–20 FAARM endline survey included measures on infant and young child feeding (IYCF), responsive feeding, and family care indicators. Data were collected on 1,142 children (0–39 months of age) and sub-samples were analyzed based on age restrictions for IYCF (6–23m) and responsive feeding (6–39m). We used multilevel linear and logistic regression to assess intervention impact, adjusting for child age and cluster. Results Children in the FAARM intervention group were more likely to have achieved minimum dietary diversity (OR (95% CI): 1.9 (1.3, 2.7)), minimum adequate diet (OR (95% CI): 1.9 (1.3, 2.7)), and more likely to have received a vitamin A capsule in the last six months (OR (95% CI): 1.6 (1.2, 2.1)). In their home environment, children in the intervention group had toys from a greater number of sources and were more likely to have toys for pretending. No differences were seen in exclusive breastfeeding, iron-rich food consumption, or responsive feeding indicators. Conclusions The FAARM intervention was able to improve children's diets and selected aspects of child stimulation. Funding Sources The Federal German Ministry of Education and Research (BMBF) is the primary funder of the FAARM trial and its HFP intervention.

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...

Impact of intervention on nutritional status of under-fives in tribal blocks of Palghar District in Maharashtra, India.

There is a need to improve their nutritional status of under-five children through specific targeted interventions. The present study discusses the impact of intervention on nutritional status among under-five children in Palghar district from Maharashtra. The objective is to improve the nutritional status of under-five children by implementing multi-component health and nutrition education intervention, focusing on dietary counseling and modification keeping in view the cultural and socio-economic status of population. A prospective pre- and post-intervention study was conducted in two tribal blocks. Total 480 under-five children were included in pre- and post-intervention survey each. Exclusive breastfeeding rates improved from 48.9% to 50.5% and initiation of complementary feeding at 6 months improved from 48.3% to 72.5% in post intervention survey as compared to preintervention survey. Among other Infant and Young Child Feeding indicators, Minimum Meal Frequency increased significantly to 67.03% from 5.91% and minimum acceptable diet improved from 5.37% to 47.2% in post intervention survey. The prevalence of Severe Acute Malnutrition (SAM) reduced from 5.4% to nil whereas severe stunting and underweight significantly decreased by 17% and 8% respectively in post intervention survey. Severe anemia decreased from 16.24% to nil post intervention. The study reveals a substantial improvement in timely initiation of complementary feeds, nil cases of SAM, stunting, and underweight along with severe anemia in postintervention phase. This highlights the impact of multicomponent health and nutrition education interventions which may be adapted at a programmatic level to reduce child mortality and morbidity in India.

Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children.

Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10–33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37–0.74, p < 0.001; OR 0.55; 95%CI: 0.39–0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.

Rates and time trends in the consumption of breastmilk, formula, and animal milk by children younger than 2 years from 2000 to 2019: analysis of 113 countries

SummaryBackgroundPrevious analyses of trends in feeding indicators of children younger than 2 years have been limited to low-income and middle-income countries. We aimed to assess time trends in the consumption of different types of milk (breastmilk, formula, and animal milk) by children younger than 2 years from 2000 to 2019 at a global level.MethodsIn this time-series analysis, we combined cross-sectional data from 487 nationally representative surveys from low-income and middle-income countries and information from high-income countries to estimate seven infant and young child feeding indicators in up to 113 countries. Multilevel linear models were used in pooled analyses to estimate annual changes in feeding practices from 2000 to 2019 for country income groups and world regions.FindingsFor the absolute average annual changes, we found significant gains in any breastfeeding at age 6 months in high-income countries (1·29 percentage points [PPs] per year [95% CI 1·12 to 1·45]; p<0·0001) and at age 1 year in high-income countries (1·14 PPs per year [0·99 to 1·28]; p<0·0001) and upper-middle-income countries (0·53 PPs per year [0·23 to 0·82]; p<0·0001). We also found a small reduction in low-income countries for any breastfeeding at age 6 months (−0·07 PPs per year [–0·11 to −0·03]; p<0·0001) and age 1 year (−0·13 PPs per year [–0·18 to −0·09]; p<0·0001). Data on exclusive breastfeeding and consumption of formula and animal milk were only available for low-income and middle-income countries, where exclusive breastfeeding in the first 6 months of life increased by 0·70 PPs per year (0·51–0·88; p<0·0001) to reach 48·6% (41·9–55·2) in 2019. Exclusive breastfeeding increased in all world regions except for the Middle East and north Africa. Formula consumption in the first 6 months of life increased in upper-middle-income countries and in east Asia and the Pacific, Latin America and the Caribbean, the Middle East and north Africa, and eastern Europe and central Asia, whereas the rates remained below 8% in sub-Saharan Africa and south Asia. Animal milk consumption by children younger than 6 months decreased significantly (−0·41 PPs per year [–0·51 to −0·31]; p<0·0001) in low-income and middle-income countries.InterpretationWe found some increases in exclusive and any breastfeeding at age 6 months in various regions and income groups, while formula consumption increased in upper-middle-income countries. To achieve the global target of 70% exclusive breastfeeding by 2030, however, rates of improvement will need to be accelerated.FundingBill & Melinda Gates Foundation, through WHO.

Factors Associated With Recommended Complementary Feeding Practices Among Children in Sidama and Oromia Regions in Ethiopia

Abstract Objectives To determine complementary feeding practices (CFP) among 6-to-23-month-old children and to identify associations between maternal and household characteristics with CFP. Methods Cross-sectional study conducted among rural communities located within the Sidama and Oromia regions in Ethiopia. Pairs of mothers and their children (N = 190) were randomly selected to participate in the survey. Data was collected using the WHO Infant and Young Child Feeding indicators, Household Food Insecurity Access Scale, and Knowledge on CFP. Multivariate logistic regressions were used to analyze factors associated with CFP. Results Most (87.4%) of the children achieved minimum meal frequency, while only 27.4% achieved minimum dietary diversity (MDD) and 26.8% minimum acceptable diet (MAD). Majority (80%) of the households were food insecure, with 40% of the households reporting severe food insecurity. Half (50.0%) of participating mothers showed poor levels of knowledge on CFP. Children of employed mothers were more likely to meet MDD (P = .014) and achieve MAD (P = .034). Furthermore, children of mothers that had adequate knowledge on the recommended CFP were more likely to achieve MDD (P &amp;lt; .001) and MAD (P &amp;lt; .001). In contrast, children living in households with an estimated annual income lower than $254 dollars were less likely to achieve MDD (P &amp;lt; .05) and MAD (P &amp;lt; .05). Similarly, children living in households with moderate to severe levels of food insecurity were less likely to achieve MDD (P = .003 and P = .012, respectively) and MAD (P = .005 and P = .023, respectively). Conclusions Complementary feeding practices were suboptimal in the Sidama and Oromia region in Ethiopia. Low household income and food insecurity seem to hinder the achievement of MDD and MAD, while maternal employment and knowledge on CFP contributed to a diversified and adequate diet among children. Thus, policies and interventions that target poverty, food insecurity, maternal unemployment, and nutrition education are necessary for the improvement of CFP. Funding Sources United States Agency for International Development (USAID) Bureau for Food Security as part of Feed the Future Innovation Lab for Livestock Systems.

The Saqmolo’ Project: Protocol for a Randomized Controlled Trial Examining the Impact of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala

Abstract Objectives Studies in Ecuador and Malawi have demonstrated mixed effects of interventions involving daily complementary feeding of eggs on child growth. For example, in Malawi, the egg intervention had no overall effect on child development. There is a need to test the effects of egg interventions on child growth and development in other settings with high prevalence of stunting and in the context of other nutritional interventions. The Saqmolo’ (i.e.,“egg” in the Mayan language, Kaqchiquel) study aims to evaluate the impact of adding 1 egg per day to local standard nutrition care (LSNC) on child development, in rural Maya infants from Guatemala. Methods In a community-based, individually randomized, controlled comparative effectiveness trial among rural indigenous Maya children (n = 1200), starting at 6–9 months at baseline, we will compare the impact of adding one egg per day to LSNC with LSNC alone. LSNC includes: growth monitoring, medical care, deworming medication, multiple micronutrient powders for point of use food fortification, and individualized complementary and responsive feeding education for caregivers. Intervention and control groups will be visited once per month during 6-months and adherence will be monitored during the visits and through phone calls for the first 2 months in both groups at the same frequency. The primary outcome is differences in child global development (measured by Caregiver Reported Child Development Instruments –CREDI-and the Guide for Monitoring Child Development GMCD); secondary outcomes include: growth (z-scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality (using the World Health Organization's infant and young child feeding indicators). Results N/A (submitting study protocol abstract). Conclusions This study will provide new evidence on the potential effect of increased egg accessibility in high prevalence stunting areas along with integrated nutrition care on child development. The results may help to inform public health decision-making regarding resource allocation for effective nutrition interventions during the complementary feeding period in Guatemala. Funding Sources This work was supported by the Academy of Nutrition and Dietetics Foundation via an investigator-initiated research grant from the Egg Nutrition Center.

Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala

Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo’ Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo’ (ie, “egg” in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu’ Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization’s infant and young child feeding indicators. The results of the Saqmolo’ Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.