Dissimilarities across age groups in the associations between complementary feeding practices and child growth: Evidence from rural Togo

Abstract The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households’ access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6–23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6–23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6–23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.

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Effect of Different Complementary Feeding on Iron Deficiency Anemia and Growth in Breastfed Infants: Home-Made VS Commercial

Folia Medica Indonesiana ◽

10.20473/fmi.v55i2.14337 ◽

2019 ◽

Vol 55 (2) ◽

pp. 112

Author(s):

Roedi Irawan ◽

Nur Aisiyah Widjaja ◽

Meta Herdiana Hanindita

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Iron ◽

Complementary Feeding ◽

Feeding Practices ◽

Child Growth ◽

Complementary Food ◽

Deficiency Anemia ◽

Complementary Foods ◽

Breastfed Infants

After approximately 6 months of age, term breastfed infants are increasingly depend on other sources of iron to avoid iron deficiency anemia, due to the depletion of the low concentration of iron in human milk. The appropriate complementary feeding must include a balance composition of foods containing an adequate amount of macro- and micronutrients to avoid iron deficiency anemia. This study aimed to compare the risk of iron deficiency and growth in breastfeed infants receiving commercial fortified complementary foods or home-made. A cross-sectional study was held on April-June 2016 to evaluate infants aged 6-24 months with breast feeding intake for 6 month of life. Complementary feeding practices were determined by questionnaire; an unquantified food frequency and feeding practices questionnaire was used to determine usual food intake. Biochemical assessment of haemoglobin (Hb), serum ferritin (SF) and serum iron (SI) level were measured. Anthropometric were assessed using WHO Child Growth Standard 2005. Statistical analysis used were Chi-square Test. Thirty eight infants were enrolled, mean age of 16.2 (SD 10.5) months. 17 infants consumed commercial complementary foods and 21 infants use home-made. Infants with home-made had lower Hb level, SF and SI than those receiving commercial complementary food, and had higher risk of underweight, stunted and wasted. Infants with home-made complementary food had lower haemoglobin, serum feritin and serum iron levels than those in fortified complementary food CF; and a higher risk of stunted and wasted than children with commercial fortified CF.

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ShishuPushti Trial: a cluster randomized controlled trial to evaluate extended peer counselling for improving feeding practices and reducing undernutrition in children aged 0-48 months in urban Bangladesh. (Preprint)

10.2196/preprints.31475 ◽

2021 ◽

Author(s):

Seema Mihrshahi ◽

Gulshan Ara ◽

Mansura Khanam ◽

Sabrina Rasheed ◽

Kingsley Agho ◽

...

Keyword(s):

Complementary Feeding ◽

Controlled Trial ◽

Feeding Practices ◽

Child Growth ◽

Control Group ◽

The Mean ◽

Cluster Randomized ◽

Peer Counselling

BACKGROUND Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity and mortality. There are reported trials of peer counselling to improve breastfeeding; however, they did not examine the efficacy of peer counselling to improve complementary feeding or the long-term impacts on child growth and development. OBJECTIVE To assess if peer counselling of women improves breastfeeding and complementary feeding practices, child growth and reduces the prevalence of undernutrition in their children up to four years of age. METHODS This study will use a community-based, cluster randomized controlled trial (cRCT) with a superiority design and two parallel treatment arms. It will assess the impact of a peer-counselling starting in the late pregnancy to one year after delivery on child feeding practices, growth and development with follow-up until 48 months of age. The study site will be in Mirpur, a densely populated area in Dhaka. Using satellite maps and GIS mapping, we will construct 36 clusters with an average population of 5,000 people. We will recruit pregnant women in the third trimester aged 16-40 years, with no more than three living children. Trained peer counsellors will visit women at home twice before delivery, four times in the first month; then monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants will collect anthropometric measurements. The primary outcome will be differences in child stunting and mean length-for-age at 6, 12, 15, 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding, in the mean duration of any breastfeeding, in the percentage of children at 6 and 9 months of age who receive solid, semi-solid or soft foods and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15 and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). RESULTS We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socio-economic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention, and 551 in the control group. From January 2015 to February 2017, we conducted the long term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. CONCLUSIONS This study will help fill the evidence gap about the short- and long-term impact of peer counselling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. CLINICALTRIAL NCT01333995

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Combining Intensive Counseling by Frontline Workers with a Nationwide Mass Media Campaign Has Large Differential Impacts on Complementary Feeding Practices but Not on Child Growth: Results of a Cluster-Randomized Program Evaluation in Bangladesh

Journal of Nutrition ◽

10.3945/jn.116.232314 ◽

2016 ◽

Vol 146 (10) ◽

pp. 2075-2084 ◽

Cited By ~ 48

Author(s):

Purnima Menon ◽

Phuong Hong Nguyen ◽

Kuntal Kumar Saha ◽

Adiba Khaled ◽

Tina Sanghvi ◽

...

Keyword(s):

Program Evaluation ◽

Mass Media ◽

Complementary Feeding ◽

Feeding Practices ◽

Child Growth ◽

Mass Media Campaign ◽

Media Campaign ◽

Frontline Workers ◽

Cluster Randomized

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

Current Developments in Nutrition ◽

10.1093/cdn/nzaa162 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Hasina Rakotomanana ◽

Deana Hildebrand ◽

Gail E Gates ◽

David G Thomas ◽

Fanjaniaina Fawbush ◽

...

Keyword(s):

Low Income ◽

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Child Growth ◽

Maternal Knowledge ◽

Complementary Foods ◽

Child Feeding ◽

Attitudes And Practices ◽

Child Undernutrition

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

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Effect of an Integrated Package of Nutrition Behavior Change Interventions on Infant and Young Child Feeding Practices and Child Growth from Birth to 18 Months: Cohort Evaluation of the Baduta Cluster Randomized Controlled Trial in East Java, Indonesia

Nutrients ◽

10.3390/nu12123851 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3851

Author(s):

Umi Fahmida ◽

Min Kyaw Htet ◽

Elaine Ferguson ◽

Tran Thanh Do ◽

Annas Buanasita ◽

...

Keyword(s):

Young Child ◽

Dietary Diversity ◽

Age Groups ◽

Intervention Group ◽

Feeding Practices ◽

Child Growth ◽

Child Feeding ◽

Young Child Feeding ◽

Behavior Change Interventions ◽

Infant And Young Child

The need for a multisectoral approach to tackle stunting has gained attention in recent years. Baduta project aims to address undernutrition among children during their first 1000 days of life using integrated nutrition-specific and nutrition-sensitive interventions. We undertook this cohort study to evaluate the Baduta project’s effectiveness on growth among children under 2 years of age in two districts (Sidoarjo and Malang Districts) in East Java. Six subdistricts were randomly selected, in which three were from the intervention areas, and three were from the control areas. We recruited 340 pregnant women per treatment group during the third trimester of pregnancy and followed up until 18 months postpartum. The assessment of breastfeeding and complementary feeding practices used standard infant and young child feeding (IYCF) indicators in a tablet-based application. We measured weight and length at birth and every three-months after that. The enumerators met precision and accuracy criteria following an anthropometry standardization procedure. Among the breastfed children, the percentage of children who achieved the minimum dietary diversity score (DDS) and minimum acceptable diet (MAD) was higher for the intervention group than the comparison group across all age groups. The odd ratios were 3.49 (95% CI: 2.2–5.5) and 2.79 (95% CI: 1.7–4.4) for DDS and 3.49 (95% CI: 2.2–5.5) and 2.74 (95% CI: 1.8–5.2) for MAD in the 9–11 month and 16–18-month age groups, respectively. However, there was no significant improvement in growth or reduction in the prevalence of anemia. The intervention was effective in improving the feeding practices of children although it failed to show significant improvement in linear growth of children at 18 months of age.

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Effect of Different Complementary Feeding on Iron Deficiency Anemia and Growth in Breastfed Infants: Home-Made VS Commercial

Folia Medica Indonesiana ◽

10.20473/fmi.v55i2.24594 ◽

2021 ◽

Vol 55 (2) ◽

pp. 112

Author(s):

Roedi Irawan ◽

Nur Aisiyah Widjaja ◽

Meta Herdiana Hanindita

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Serum Iron ◽

Complementary Feeding ◽

Feeding Practices ◽

Child Growth ◽

Complementary Food ◽

Deficiency Anemia ◽

Complementary Foods ◽

Breastfed Infants

After approximately 6 months of age, term breastfed infants are increasingly depend on other sources of iron to avoid iron deficiency anemia, due to the depletion of the low concentration of iron in human milk. The appropriate complementary feeding must include a balance composition of foods containing an adequate amount of macro- and micronutrients to avoid iron deficiency anemia. This study aimed to compare the risk of iron deficiency and growth in breastfeed infants receiving commercial fortified complementary foods or home-made. A cross-sectional study was held on April-June 2016 to evaluate infants aged 6-24 months with breast feeding intake for 6 month of life. Complementary feeding practices were determined by questionnaire; an unquantified food frequency and feeding practices questionnaire was used to determine usual food intake. Biochemical assessment of haemoglobin (Hb), serum ferritin (SF) and serum iron (SI) level were measured. Anthropometric were assessed using WHO Child Growth Standard 2005. Statistical analysis used were Chi-square Test. Thirty eight infants were enrolled, mean age of 16.2 (SD 10.5) months. 17 infants consumed commercial complementary foods and 21 infants use home-made. Infants with home-made had lower Hb level, SF and SI than those receiving commercial complementary food, and had higher risk of underweight, stunted and wasted. Infants with home-made complementary food had lower haemoglobin, serum feritin and serum iron levels than those in fortified complementary food CF; and a higher risk of stunted and wasted than children with commercial fortified CF.

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Maternal determinants of optimal breastfeeding and complementary feeding and their association with child undernutrition in Malawi (2015–2016)

BMC Public Health ◽

10.1186/s12889-019-7877-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Christine N. Walters ◽

Hasina Rakotomanana ◽

Joel J. Komakech ◽

Barbara J. Stoecker

Keyword(s):

Urban Areas ◽

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Child Growth ◽

Meal Frequency ◽

Maternal Characteristics ◽

Child Undernutrition ◽

Maternal Determinants ◽

Minimum Dietary Diversity

Abstract Background Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting. Methods The most recent Malawi Demographic Health Survey (2015–2016) was used and data for 2294 children aged 0–23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women’s empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p-value of < 0.05 were considered significant in the final model. Results Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13–23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight. Conclusions Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.

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Complementary Feeding Practices and Child Growth in a Region with a High Burden of Child Undernutrition in Madagascar

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_096 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 891-891

Author(s):

Hasina Rakotomanana ◽

Deana Hildebrand ◽

Gail Gates ◽

David Thomas ◽

Barbara Stoecker

Keyword(s):

Complementary Feeding ◽

Dietary Diversity ◽

Survey Design ◽

Feeding Practices ◽

Optimal Growth ◽

Child Growth ◽

Linear Regression Models ◽

Cross Sectional ◽

Growth Standards ◽

Child Undernutrition

Abstract Objectives The Vakinankaratra region of Madagascar has the highest stunting rates of the country, yet it is one of most agriculturally productive regions. The purpose of this study was to assess maternal complementary feeding practices and their association with child growth. Methods Data from a cross-sectional study of 391 mothers and their infants aged 6–23 months were analyzed. The WHO infant and young child feeding (IYCF) indicators were used to assess complementary feeding practices. A questionnaire for collection of sociodemographic information and 24-hour dietary recall was translated and pre-tested before data collection. Child length and weight were converted to length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) using the 2006 WHO Growth Standards. Linear regression models were conducted while adjusting for survey design and confounding variables. Results Stunting (69.4%) and undernutrition (23.4%) rates were very high. The proportion of children achieving minimum dietary diversity (35.8%), minimum acceptable diet (30.2%) and consuming flesh foods (14.1%) were low. Higher dietary diversity score was associated with increased LAZ [β = 0.2, P < 0.05, R2 = 0.16] in 9–11 months infants only. Consuming flesh foods was associated only with higher WAZ [β = 0.41, P < 0.01, R,2 = 0.10]. None of the indicators were associated with WLZ. Conclusions Complementary feeding practices were suboptimal in the Vakinankaratra region. Although crucial for optimal growth, improving feeding practices alone may not be sufficient to reduce the high prevalence of child undernutrition in the region. Funding Sources This study was funded by the Marilynn Thoma Chair in Human Sciences at Oklahoma State University.

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