Infant and Young Child Feeding Practices in Southeast Asia: associations with socioeconomic status, child nutrition and longer-term growth trajectories

Despite a breadth of research evidencing the association between exclusive breastfeeding and child growth, little is known about infant feeding practices and diet diversity in low- and middle-income countries. In these settings, the weaning transition offers a critical window in which nutritional inputs can help establish the path to lifelong health, yet only one in six young children receives an adequate diet necessary for optimal growth and development. A distinctive nutrition transition in Southeast Asia has coincided with significant economic growth, with the emergence of a double burden of malnutrition. Chronic and persistent undernutrition in young Southeast Asian children is increasingly coupled with rising prevalence of malnutrition, as diets rapidly “westernize” in line with GDP growth and increasing socioeconomic inequalities. This thesis aimed to examine the role of early feeding practices on child nutritional status and growth in light of this nutrition transition, in three economically and culturally diverse Southeast Asian countries (Cambodia, Myanmar and Indonesia). Given the rapid economic and socio-cultural shifts in this region, the role of socioeconomic status on early life feeding practices and dietary diversity is a focus throughout the thesis. Using the most recent DHS data from all three countries, the first analysis in this thesis presents a sub-regional snapshot of the socioeconomic factors associated with exclusive breastfeeding in children aged 0 to <6 months and minimum dietary diversity in children aged 6 to <24 months. The second analysis used structural path analysis to examine the role of continued breastfeeding and dietary diversity in pathways to stunting in Cambodia and how these varied according to contextually relevant, underlying socioeconomic factors. The final analysis in this thesis applied group-based trajectory modelling to longitudinal data from the Indonesian Family Life Survey, to identify BMI growth trajectories and examine early life feeding practices associated with BMI trajectory membership. Overall, evidence from Cambodia, Myanmar and Indonesia demonstrates that exclusive and continued breastfeeding and dietary diversity in young children are clearly defined by socioeconomic conditions. The research presented in this thesis further suggests that feeding practices during the first two years of life play significant mediating roles in the complex pathways between underlying socioeconomic factors and short-term nutritional status in young children, however these associations are harder to identify over longer periods of study, due to the limitations of observational studies. Keywords: Dietary diversity; breastfeeding; Southeast Asia; child nutrition; nutrition transitio

Maternal socioeconomic status and infant feeding practices underlying pathways to child stunting in Cambodia: structural path analysis using cross-sectional population data

Objectives: To identify and investigate complex pathways to stunting among children aged 6–24 months to determine the mediating effects of dietary diversity and continued breast feeding on the association between socioeconomic factors and child stunting.Design, setting and participants: We analysed the most recent cross-sectional Demographic and Health Survey data from Cambodia (2014). We applied structural path analysis on a sample of 1365 children to model the complex and inter-related pathways of factors determining children’s height for age. Explanatory variables included a composite indicator of maternal employment, household wealth, maternal education, current breastfeeding status and dietary diversity score. Results are presented both in terms of non-standardised and standardised coefficients.Outcome measure: The primary outcome measure was height-for-age Z-scores as a continuous measure.Results: Findings suggest that children’s dietary diversity and continued breast feeding mediate the association between socioeconomic status and children’s height. While there was no significant direct effect of maternal education on children’s height, results suggested significant indirect pathways through which maternal education effects children’s height; operating through household wealth, maternal employment, dietary diversity and continued breastfeeding status (p<0.001). Most notably, 41% of the effect of maternal employment on children’s height was mediated by either dietary diversity or continued breast feeding.Conclusion: We provide evidence to support targeted nutrition interventions which account for the different ways in which underlying socioeconomic factors influence infant and young child feeding practices, and the potential impact on child nutritional status

Trends in adolescent first births in five countries in Latin America and the Caribbean: disaggregated data from demographic and health surveys

Background: adolescents in the Latin American and Caribbean region continue to experience poor reproductive health outcomes, including high rates of first birth before the age of 20 years. Aggregate national level data fails to identify groups where progress is particularly poor. This paper explores how trends in adolescent births have changed over time in five countries (Bolivia, Colombia, Dominican Republic, Haiti, and Peru) using data disaggregated by adolescent age group, wealth and urban / rural residence.Methods: the study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence.Results: there has been little progress in reducing adolescent first births over the last two decades in these countries. Adolescent first births continue to be more common among the poorest and rural residents, and births among the youngest age-group (< 16 years) are particularly concentrated among these populations.Conclusion: adolescent first births continue to be a major issue in these five countries, including amongst the youngest group (< 16 years), although the contexts in which it is occurring are changing over time. Efforts are needed to expand sexual education and services for adolescents and young people, as well as introduce and enforce legislation to provide effective protection from abuse or exploitation. Greater disaggregation of adolescent fertility data is needed if we are to measure progress towards the attainment of the Sustainable Development Goals to “leave no-one behind”

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc