Situation and determinants of the infant and young child feeding (IYCF) indicators in Madagascar: analysis of the 2009 Demographic and Health Survey

Background: Studies evaluating child feeding in Madagascar are scarce despite its importance in child growth during the first two years of life. This study assessed the associations between the WHO infant and young child feeding (IYCF) indicators and stunting and identified determinants of inappropriate child feeding practices.Methods: The most recent Demographic and Health Survey was used including a total of 1956 infants aged 0–23 months. Logistic regressions were performed for the association between IYCF indicators and stunting and for the determination of risk factors for inappropriate feeding practices.Results: The rates of initiation of breastfeeding within one hour after birth (77.2%), continued breastfeeding at one year (99.6%) and timely introduction of solid, semi-solid or soft foods at 6–8 months (88.3%) were high. Exclusive breastfeeding under 6 months (48.8%), attaining minimum dietary diversity (22.2%) and consumption of iron-rich foods (19.6%) were relatively low. Higher length-for-age was associated with achieving minimum dietary diversity (p<0.01). The other indicators assessed (early initiation of breastfeeding, exclusive breastfeeding under 6 months, timely introduction of complementary foods and consumption of iron-rich foods) were not associated with stunting. Infants born to mothers who had first given birth at an age younger than 19 were more likely not to be breastfed within one hour after birth, not to be exclusively breastfed and not to have the recommended dietary diversity. Infants whose mothers had low media exposure were at increased risk of being inappropriately fed. Low household wealth also was associated with higher odds of not meeting the minimum dietary diversity.Conclusions: Despite almost total continued breastfeeding at one year and early initiation of breastfeeding by more than three-quarter of mothers, minimum dietary diversity scores were still low, confirming the need for more effective programs for improving child feeding practices in Madagascar. Improving dietary diversity in children aged 6–23 months may help reduce stunting. The identified risk factors for inappropriate feeding practices could be used in directing future nutrition sensitive interventions.Peer reviewedNutritional Science

Infant And Young Child Feeding (Iycf) Practices In Ethiopia And Zambia And Their Association With Child Nutrition: Analysis Of Demographic And Health Survey Data

Data from the 2005 Ethiopia Demographic and Health Survey (EDHS) and the 2007 Zambia Demographic Health Survey (ZDHS) were analyzed to examine the association between World Health Organization (WHO) recommended IYCF indicators and nutritional status among children 0-23 months of age in Ethiopia and Zambia. A total of 1810 and 2512 children within this age group from Ethiopia and Zambia, respectively, were included in the analysis. Exclusive breast-feeding among children 0-5.9 months of age is low in both Ethiopia (43 %) and Zambia (51 %). Timely introduction of complementary food is lower in Ethiopia (61 %) compared to Zambia (90 %). Only 7 percent of children between 6-23 months of age consumed diets that met the minimum dietary diversity requirement of four or more food groups consumed per day compared to 37 % in Zambia. Multiple linear and logistic regression analyses using appropriate measures to account for the complex survey design were applied to examine the associations between IYCF practices and child anthropometry. Linear regression results show that exclusive breast-feeding (EBF) is positively associated with weight-for-height z-score (WHZ) (effect size (ES) 0.65; p<0.001) and weight-for-age z-score (WAZ) (ES 0.28; p<0.01) in Zambia. In Ethiopia, EBF under 6 months of age is negatively associated with height-for-age z-score (HAZ) (ES 0.81; p<0.01). Timely introduction of complementary food between 6-8 months of age was positively associated with HAZ (ES 1.19; p<0.01) in Zambia. Higher dietary diversity score was associated with higher HAZ (ES 0.23, p<0.001 in Ethiopia; ES 0.12, p<0.01 in Zambia) and WAZ (ES 0.17, p<0.001 in Ethiopia; ES 0.04, p<0.10 in Zambia) in both countries. The findings demonstrate the need to reinforce age- appropriate IYCF practices to address child undernutrition. Special attention is needed to improve the complementary feeding practices, particularly diet diversity for children 6-23 months of age, while sustaining a focus on EBF among children under 6 months of age, in order to improve overall nutritional status of young children in Ethiopia and Zambia