A Multisectoral Nutrition Program in Nepal Improves Knowledge of Dietary Diversity, Sick Child Feeding, and Handwashing, but Not All Practices: a Program Impact Pathways Mediation Analysis

ABSTRACT Background Few intervention studies have focused on how inputs link with outcomes. Objectives This study tested whether Suaahara I program inputs translated into intended outcomes and identified gaps along the theorized program impact pathway to improved nutrition, care, and water, sanitation, and hygiene behaviors. Methods We used household-level, cross-sectional survey data from a process evaluation of Suaahara I conducted in 2014. A total of 480 households with a pregnant woman or child aged <2 y were selected with an equal split between intervention and comparison arms. We used regression models to test associations between exposure to Suaahara I and 3 primary outcomes and 3 parallel knowledge mediators: child minimum dietary diversity, child feeding during illness, and proper handwashing during child care. We used generalized structural equation modeling using full information maximum likelihood to test whether knowledge mediated associations between exposure and outcomes. Results In the adjusted regression models between maternal exposure to Suaahara I and 3 behavioral outcomes, we found a small positive association for handwashing (β: 0.21; 95% CI: 0.10, 0.31), but no association with the other 2 outcomes. In the mediation analysis, maternal exposure to Suaahara I, however, was associated with the mediator (knowledge) for all 3 outcomes: handwashing with soap and water (β: 0.05 ± 0.02), child minimum dietary diversity (logit = 0.06; P = 0.03), and child feeding during illness (logit = 0.09 ± 0.02). We found a positive, significant association for the full indirect pathway of program input to output via knowledge for child feeding during illness (logit = 0.07 ± 0.03) only. Conclusions Exposure to Suaahara I behavior change interventions improved knowledge, but this did not always translate into improved practices. It is important to address barriers to optimal practices beyond knowledge in future nutrition programs in Nepal.

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Association between women’s empowerment and infant and child feeding practices in sub-Saharan Africa: an analysis of Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980015002621 ◽

2015 ◽

Vol 18 (17) ◽

pp. 3155-3165 ◽

Cited By ~ 39

Author(s):

Muzi Na ◽

Larissa Jennings ◽

Sameera A Talegawkar ◽

Saifuddin Ahmed

Keyword(s):

Sierra Leone ◽

Dietary Diversity ◽

Women's Empowerment ◽

Sub Saharan Africa ◽

Women’S Empowerment ◽

Demographic And Health Surveys ◽

Meal Frequency ◽

Child Feeding ◽

Sub Saharan ◽

Minimum Dietary Diversity

AbstractObjectiveTo explore the relationship between women’s empowerment and WHO recommended infant and young child feeding (IYCF) practices in sub-Saharan Africa.DesignAnalysis was conducted using data from ten Demographic and Health Surveys between 2010 and 2013. Women’s empowerment was assessed by nine standard items covering three dimensions: economic, socio-familial and legal empowerment. Three core IYCF practices examined were minimum dietary diversity, minimum meal frequency and minimum acceptable diet. Separate multivariable logistic regression models were applied for the IYCF practices on dimensional and overall empowerment in each country.SettingBenin, Burkina Faso, Ethiopia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Uganda and Zimbabwe.SubjectsYoungest singleton children aged 6–23 months and their mothers (n 15 153).ResultsLess than 35 %, 60 % and 18 % of children 6–23 months of age met the criterion of minimum dietary diversity, minimum meal frequency and minimum acceptable diet, respectively. In general, likelihood of meeting the recommended IYCF criteria was positively associated with the economic dimension of women’s empowerment. Socio-familial empowerment was negatively associated with the three feeding criteria, except in Zimbabwe. The legal dimension of empowerment did not show any clear pattern in the associations. Greater overall empowerment of women was consistently and positively associated with multiple IYCF practices in Mali, Rwanda and Sierra Leone. However, consistent negative relationships were found in Benin and Niger. Null or mixed results were observed in the remaining countries.ConclusionsThe importance of women’s empowerment for IYCF practices needs to be discussed by context and by dimension of empowerment.

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The Influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania

10.21203/rs.2.16657/v1 ◽

2019 ◽

Author(s):

Ahmed Gharib Khamis ◽

Akwilina Wendelin Mwanri ◽

Julius Edward Ntwenya ◽

Katharina Kreppel

Keyword(s):

Fruits And Vegetables ◽

Dietary Diversity ◽

Secondary Data ◽

Food Group ◽

Limited Information ◽

Food Groups ◽

Child Feeding ◽

Young Child Feeding ◽

Nutritional Status Of Children ◽

Minimum Dietary Diversity

Abstract Background Undernutrition poses a serious health challenge in developing countries. Tanzania has the highest undernutrition burdens in East and Southern Africa. Poor infant and young child feeding practices including consumption of undiversified diet are the main cause for undernutrition. There is limited information regarding the association between dietary diversity and undernutrition in Tanzania. The objective of this paper was to examine to what extent the dietary diversity is associated with undernutrition of children of 6 to 23 months in Tanzania.Methods This is a secondary data analysis from data collected by the Tanzania Demographic and Health Survey of 2015-2016. Stunting, wasting and underweight were calculated from Z-scores based on 2006 WHO standards. A dietary diversity score was created by summing the number of food groups reported for each child by the mother ranging from 0 to 7. Then, a Minimum Dietary Diversity (MDD) indicator was used to assess the diversity of the diet given to children. Bivariate and multivariate logistic regression techniques were used to assess the odds ratios of becoming undernourished.Results A total of 2,960 children were enrolled in this study. The majority (73.9%) of children did not reach the recommended Minimum Dietary Diversity (MDD). The most commonly consumed types of foods were grains, roots and tubers (91%), and Vitamin A containing fruits and vegetables (65%). Consumption of a diverse diet was significantly associated with a reduction of stunting, wasting and being underweight in children. The likelihood of being stunted, wasted and underweight was found to decrease as the number of food group consumed increased. Children who did not received an MDD diet had a significantly higher likelihood of being stunted (AOR=1.37, 95% CI; 1.13-1.65) and underweight (AOR=1.49, 95% CI; 1.15-1.92), but this was not the case for wasting. Consumption of animal source foods has been found to be associated with reduced stunting among children.Conclusion Consumption of a diverse diet was associated with a reduction in undernutrition among children of 6 to 23 months in Tanzania. Measures to improve the type of complementary foods in order to meet the energy and nutritional demands of children should be considered in Tanzania.

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Core and optional infant and young child feeding indicators in Sub-Saharan Africa: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-023238 ◽

2019 ◽

Vol 9 (2) ◽

pp. e023238 ◽

Cited By ~ 2

Author(s):

Samson Gebremedhin

Keyword(s):

Young Child ◽

Dietary Diversity ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Child Feeding ◽

Cross Sectional ◽

Young Child Feeding ◽

Infant And Young Child ◽

Sub Saharan ◽

Minimum Dietary Diversity

ObjectiveThe objective of the study is to determine the status of infant and young child feeding (IYCF) in Sub-Saharan Africa (SSA) based on multiple indicators.DesignSecondary data analysis of 32 Demographic and Health Surveys conducted in SSA since 2010.SettingThirty-two countries in SSA.Participants151 575 infants and young children born in the preceding 2 years of the surveys.Indicators determinedEight core and six optional IYCF indicators.ResultsMajority (95.8%) of the children born in the preceding 24 months were ever breastfed, and 50.5% initiated breastfeeding within the first hour of birth. Among infants 0–5 months of age, 72.3% were predominantly breastfed and 41.0% were exclusively breastfed. Continued breastfeeding at 1 year (89.5%) was reasonably high, but only 53.7% continued breastfeeding at 2 years and 60.4% had age-appropriate breastfeeding. About two-thirds (69.3%) of infants 6–8 months of age received solid, semisolid or soft food over the previous day across the countries. Among children 6–23 months of age, 41.9% met the minimum recommended meal frequency, while smaller proportions satisfied the minimum dietary diversity (21.0%) and acceptable diet (9.8%). About one-third (37.6%) of children 6–23 months of age consumed iron-rich or iron-fortified food over the previous day. Among non-breastfed children, only 15.0% received the recommended two or more milk feedings. Thirteen per cent were fed with a bottle with a nipple in the previous day. Country-level estimates for most indicators showed remarkable variations. Yet the minimum dietary diversity and acceptable diet indicators were consistently low.ConclusionMost breastfeeding-related indicators, except exclusive and early initiation of breastfeeding, are in an acceptable level in SSA. However, complementary feeding indicators are generally low.

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Behavior Change Interventions Delivered through Interpersonal Communication, Agricultural Activities, Community Mobilization, and Mass Media Increase Complementary Feeding Practices and Reduce Child Stunting in Ethiopia

Journal of Nutrition ◽

10.1093/jn/nxz087 ◽

2019 ◽

Vol 149 (8) ◽

pp. 1470-1481 ◽

Cited By ~ 8

Author(s):

Sunny S Kim ◽

Phuong Hong Nguyen ◽

Yisehac Yohannes ◽

Yewelsew Abebe ◽

Manisha Tharaney ◽

...

Keyword(s):

Behavior Change ◽

Interpersonal Communication ◽

Complementary Feeding ◽

Dietary Diversity ◽

Agricultural Activities ◽

Child Stunting ◽

Behavior Change Interventions ◽

Path Analyses ◽

Intensive Group ◽

Minimum Dietary Diversity

ABSTRACT Background Appropriate infant and young child feeding practices are critical for optimal child growth and development, but in Ethiopia, complementary feeding (CF) practices are very poor. Alive & Thrive (A&T) provided intensive behavior change interventions through 4 platforms: interpersonal communication (IPC), nutrition-sensitive agricultural activities (AG), community mobilization (CM), and mass media (MM). Objectives The aim of this study was to evaluate the impact of A&T intensive compared with nonintensive interventions (standard nutrition counseling and agricultural extension service and less intensive CM and MM) on CF practices and knowledge and child anthropometric outcomes. Methods We used a cluster-randomized evaluation design with cross-sectional surveys among households with children aged 6–23.9 mo [n = 2646 at baseline (2015) and n = 2720 at endline (2017)]. We derived difference-in-difference impact estimates (DDEs) and conducted dose–response and path analyses to document plausibility of impacts. Results At endline, exposure to IPC was 17.8–32.3%, exposure to AG was 22.7–36.0%, exposure to CM was 18.6–54.3%, and exposure to MM was 35.4% in the intensive group. Minimum dietary diversity and minimum acceptable diet increased significantly in the intensive group but remained low at endline (24.9% and 18.2%, respectively). Significant differential declines in stunting prevalence were observed (DDE: −5.6 percentage points; P < 0.05) in children aged 6–23.9 mo, decreasing from 36.3% to 22.8% in the intensive group. Dose–response analyses showed higher odds of minimum dietary diversity (OR: 3.3; 95% CI: 2.2, 4.8) and minimum meal frequency (OR: 1.9; 95% CI: 1.4, 2.6) and higher height-for-age z score (HAZ) (β: 0.24; 95% CI: 0.04, 0.4) among women exposed to 3 or 4 platforms. Path analyses showed a strong relation between AG and egg consumption, which led to increased child dietary diversity and HAZ. Conclusions Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in CF practices and child stunting within a 2-y period. There is a need for continued efforts, however, to expand intervention coverage and to improve CF practices in Ethiopia. This trial was registered at clinicaltrials.gov as NCT02775552.

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Examining the Exposure, Timing, and Frequency of Interpersonal Communication Contacts to Improve Infant and Young Child Feeding in Bangladesh, Ethiopia, and Vietnam (P10-138-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-138-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Sunny Kim ◽

Phuong Nguyen ◽

Lan Tran ◽

Silvia Alayon ◽

Purnima Menon ◽

...

Keyword(s):

Young Child ◽

Interpersonal Communication ◽

Exclusive Breastfeeding ◽

Large Scale ◽

Food Policy ◽

Dietary Diversity ◽

Child Feeding ◽

Young Child Feeding ◽

Behavior Change Interventions ◽

Infant And Young Child

Abstract Objectives In the context of large-scale interventions to improve infant and young child feeding (IYCF) practices, we examined differences in characteristics of those exposed and not exposed to interventions; exposure to interpersonal communication (IPC), including overlap with other interventions and timing and number of contacts; and relationship between frequency of IPC contacts and IYCF practices. Methods We used endline survey data from Bangladesh (2000 mothers with children <2y, 1000 per program group), Ethiopia (1720 mother with children aged 6–23.9 mo, 1360 per group), and Vietnam (2005 mothers with children <2y, 1000 per group). Regression models were used to test differences in exposure to specific or combined interventions between two arms and relationships between the frequency of IPC contacts or exposure to interventions and IYCF practices, adjusted for child age and sex and geographic clustering. Results Those exposed to interventions had higher socioeconomic status, food security, and maternal dietary diversity. There was large overlap in exposure to IPC with other interventions in intensive-intervention areas in all 3 countries. On average, mothers received 8 visits in the last 6 mo, 2 visits in the last 3 mo, and 1 visit in the last 6 mo in Bangladesh, Ethiopia, and Vietnam respectively. In Bangladesh, there was a positive, nonsignificant association between intervention exposure and IYCF practices in intensive areas. In Ethiopia, exposure to IPC with other interventions was associated with higher odds of minimum meal frequency (OR: 1.6), minimum dietary diversity (OR: 1.8), and consumption of iron-rich foods (OR: 4.7). In Vietnam, exposure to IPC alone or with mass media was associated with 3.7 and 2.8 higher odds respectively of exclusive breastfeeding. At least monthly visits was associated with higher odds of IYCF practices in Bangladesh and Ethiopia. In Vietnam, any number of IPC visits was associated with 2 times higher odds of exclusive breastfeeding. Conclusions Effects of combined behavior-change interventions and frequency of IPC contacts may be context-specific. Funding Sources Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360; and CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute.

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The influence of feeding practice on the risk of stunting in infant and young children in developing countries:a literature review

Ilmu Gizi Indonesia ◽

10.35842/ilgi.v3i1.117 ◽

2019 ◽

Vol 3 (1) ◽

pp. 13

Author(s):

Sri Melfa Damanik ◽

Dessie Wanda

Keyword(s):

Developing Countries ◽

Young Children ◽

Literature Review ◽

English Language ◽

Dietary Diversity ◽

Feeding Practice ◽

Child Feeding ◽

Infant And Young Children ◽

Minimum Dietary Diversity ◽

Appraisal Tool

Bacground: Stunting is one of the conditions of failed to grow on the children where the child’s height is not obtained in accordance with the age of the child. There are a few things that become the main causes of stunting problem in children, as well as the ineffectiveness of child feeding practice. Objective: To find out the influence of feeding practice according to WHO guidelines on the risk of stunting in infant and young children in developing countries according on literature review. Methods: This literature review used search strategy on five databases involved Science Direct, EBSCOhost, ProQuest, Taylor & Franchis, and Scopus using the keywords of “stunting, feeding practice, infant and young children”. The author used several filter i.e. research articles, articles with English language, and published in 2008-2018. All articles were selected using Appraisal Tool of PRISMA and resulting 16 Articles. Results: Sixteen articles showed that minimum dietary diversity, exclusive breast feeding, the time of introduction of complementary feeding, high iron feeding, and frequency of feeding have a significant relationship with incident of stunting for infant and young children. Conclusion: The feeding practice for infant and young children in developing countries was not optimal. Providing education as early as possible to prospective mothers and mothers about proper feeding practices was expected can increase the knowledge and ability of mothers to practice appropriate feeding according to WHO recommendations.

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Influence of Infant and Young Child Feeding Practices on Stunting in Children Aged 6 – 23 Months in Zambia

10.21203/rs.3.rs-333111/v1 ◽

2021 ◽

Author(s):

Andrew Banda ◽

Elizabeth T. Nyirenda ◽

Chabila C. Mapoma ◽

Bwalya B. Bwalya ◽

Nkuye Moyo

Keyword(s):

Child Nutrition ◽

Dietary Diversity ◽

Public Health Problem ◽

Feeding Practices ◽

Meal Frequency ◽

Chi Square ◽

Child Feeding ◽

Young Child Feeding ◽

Main Determinants ◽

Minimum Dietary Diversity

Abstract Background Infant and child nutrition in Zambia remains a pressing public health problem. The Zambia Demographic and Health Survey (ZDHS) indicates that 35% of children under-five and 36 % among those aged 6-23 months are stunted. This study set out to assess the influence of Infant and Child Feeding (IYCF) practices on child stunting (6-23 months) in Zambia. Methods The 2008 ZDHS children’s data were analysed to measure stunting among infants aged 6-23 months. We fitted a bivariate logistic regression to measure association between feeding practices and stunting in children. Pearson’s Chi-square test of proportions measuring differences in proportions and adjusted odd ratios (AOR) with confidence intervals at 95% are reported. Results Findings indicate that 36% were stunted. IYCF practices indicators remain relatively poor in Zambia with only 13% of children age 6-23 months having received minimum acceptable diet, 23% received minimum dietary diversity and 42% received minimum meal frequency. Breastfeeding and receipt of a minimum dietary diversity reduced the odds of stunting among children age 6-23 months by 38% and 33% respectively. A child's perceived low birth size, being male, maternal anaemia status and mother's use of the internet were significant predictors of stunting.Conclusion We conclude that IYCF practices have an influence on stunting in Zambia and that socio-economic and demographic factors are likewise associated with stunting although the main determinants are amendable to intervention. Promoting the recommended WHO IYCF practices; breastfeeding, minimum meal frequency, receiving foods with diverse dietary content and accelerated investment in nutrition programs is recommended.

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Level of Knowledge and Practice of Mothers on Minimum Dietary Diversity Practices and Associated Factors for 6–23-Month-Old Children in Adea Woreda, Oromia, Ethiopia

BioMed Research International ◽

10.1155/2017/7204562 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Andualem Agize ◽

Dube Jara ◽

Getiye Dejenu

Keyword(s):

Marital Status ◽

Associated Factors ◽

Dietary Diversity ◽

Cross Sectional Study ◽

Systematic Sampling ◽

Child Feeding ◽

Cross Sectional ◽

Level Of Knowledge ◽

Knowledge And Practice ◽

Minimum Dietary Diversity

Background. Globally, undernutrition is responsible for at least 35% of deaths in children less than 5 years of age and estimated 6% of under-five deaths can be prevented by ensuring optimal complementary feeding especially the dietary diversity and meal frequency. In Ethiopia, 5% of children were fed according to minimum standards with respect to food diversity.Objective. To assess the level of knowledge and practice of mothers on dietary diversity practices and associated factors for children 6–23 months in Adea woreda.Methods. Community-based cross-sectional study was conducted. A sample of 730 mothers who have children in the age group of 6–23 months were selected using systematic sampling. Logistic regression model was fitted in order to identify factors associated with knowledge and practice of dietary diversity practice.Result. Of the total 700, 357 (51%) were knowledgeable on dietary diversity but 112 (16%) practiced appropriate dietary diversity practice for their 6–23-month-old children. Husbands’ education (AOR = 2.79, 95% CI = (1.55, 5.00)), mothers’ age, and marital status were significantly associated with knowledge of mothers. Mothers’ age, husbands’ education, marital status, and knowledge of mothers were significantly associated with mothers’ dietary diversity for 6–23-month-old children.Conclusion. This study showed that approximately half of the mothers have good knowledge on minimum dietary diversity for children 6–23 months old and very low proportion of children 6–23 months old received diversified meal according to Infant and Young Child Feeding indicators. It was identified that different factors are responsible for this discrepancy.

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Different Combinations of Behavior Change Interventions and Frequencies of Interpersonal Contacts Are Associated with Infant and Young Child Feeding Practices in Bangladesh, Ethiopia, and Vietnam

Current Developments in Nutrition ◽

10.1093/cdn/nzz140 ◽

2019 ◽

Vol 4 (2) ◽

Cited By ~ 2

Author(s):

Sunny S Kim ◽

Phuong Hong Nguyen ◽

Lan Mai Tran ◽

Silvia Alayon ◽

Purnima Menon ◽

...

Keyword(s):

Young Child ◽

Mass Media ◽

Behavior Change ◽

Dietary Diversity ◽

Child Feeding ◽

Factors Associated ◽

Young Child Feeding ◽

Behavior Change Interventions ◽

Infant And Young Child ◽

The Impact

ABSTRACT Background Social and behavior change communication interventions are integral to improving dietary and care practices, but evidence on the impact of the combination and intensity of these interventions in different contexts is scarce. Objectives We examined the extent of and factors associated with intervention exposure: interpersonal communication (IPC) alone or with other interventions (i.e., mass media, community mobilization, or nutrition-sensitive agricultural activities), number of and factors associated with IPC contacts, and combinations of intervention components and number of contacts associated with infant and young child feeding (IYCF) practices. Methods We used endline survey data from impact evaluations in Bangladesh, Ethiopia, and Vietnam (n = 1001, 1720, and 1001 mothers with children aged <2 y, respectively). Multivariable regression models were used for analyses. Results Exposure to the interventions varied in all 3 countries. On average, mothers received 8 visits in the last 6 mo in Bangladesh, 2 visits in the last 3 mo in Ethiopia, and 1 visit in the last 6 mo in Vietnam. Across countries, the factors associated with intervention exposure and number of IPC contacts differed. In Ethiopia, exposure to IPC with other interventions was associated with higher odds of achieving minimum meal frequency (OR: 1.6), minimum dietary diversity (OR: 1.8), and consumption of iron-rich foods (OR: 4.7). In Vietnam, exposure to IPC alone or with mass media was associated with higher odds of exclusive breastfeeding (EBF; OR: 2.8–3.7). Near-monthly visits were associated with 2–3 times higher odds of IYCF practices in Bangladesh and Ethiopia. In Vietnam, even 1 IPC visit was associated with 2 times higher odds of EBF. Conclusions Exposure matters for impact, but the combination of behavior change interventions and number of IPC contacts required to support IYCF behavior change are context specific. This trial was registered at www.clinicaltrials.gov as NCT01678716 (Bangladesh), NCT02775552 (Ethiopia), and NCT01676623 (Vietnam).

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

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_084 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1012-1012

Author(s):

Ayushi Jain ◽

Muneer Kalliyil ◽

Satish Agnihotri

Keyword(s):

Child Nutrition ◽

Complementary Feeding ◽

Dietary Diversity ◽

Family Health ◽

Feeding Practices ◽

Meal Frequency ◽

Child Feeding ◽

Diet Diversity ◽

Minimum Dietary Diversity ◽

Nutritional Outcomes

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.

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