Individual, household and national factors associated with iron, vitamin A and zinc deficiencies among children aged 6-59 months in Nepal

Iron, vitamin A and zinc deficiencies are the top three micronutrients contributing to disability‐adjusted life years globally. The study assessed the factors associated with iron, vitamin A, and Zinc deficiencies among Nepalese children (n = 1709) aged 6–59 months using data from the 2016 Nepal National Micronutrient Status Survey. The following cut‐off points were applied: iron deficiency [ferritin 8.3 mg/L], vitamin A deficiency (retinol‐binding protein < 0.69 μmol/L) and zinc deficiency (serum zinc < 65 μg/dl for morning sample and <57µg/dl for afternoon sample). We used multiple logistic regression adjusted for sampling weights and clustering to examine the predictors of micronutrient deficiencies. The prevalence of iron depletion (ferritin), tissue iron (sTfR), vitamin A and zinc deficiencies were 36.7%, 27.6%, 8.5% and 20.4%, respectively. Children were more likely to be iron deficient (ferritin) if aged 6–23 months, stunted, and in a middle‐wealth quintile household. Vitamin A deficiency was associated with development region and was higher among children living in severe food‐insecure households and those who did not consume fruits. Zinc deficiency was higher among children in rural areas and the poorest wealth quintile. The Government of Nepal should focus on addressing micronutrient deficiencies in the early years, with emphasis on improving food systems, promote healthy diets, among younger and stunted children and provide social cash transfer targeting high‐risk development regions, poorest and food insecure households

Regional analysis of associations between infant and young child feeding practices and diarrhoea in Indian children

Studies on the association between infant and young child feeding (IYCF) practices and diarrhoea across regional India are limited. Hence, we examined the association between IYCF practices and diarrhoea in regional India. A weighted sample of 90,596 (North = 11,200, South = 16,469, East = 23,317, West = 11,512, Central = 24,870 and North-East = 3228) from the 2015–2016 National Family Health Survey in India was examined, using multivariate logistic regressions that adjust for clustering and sampling weights. The IYCF indicators included early initiation of breastfeeding (EIBF), exclusive breastfeeding (ExcBF), predominant breastfeeding (PBF), bottle feeding (BotF), continued breastfeeding (BF) at one-year, continued BF at two years, children ever breastfed and the introduction of solid, semi-solid or soft foods (ISSSF). Diarrhoea prevalence was lower among infants who were BF within one-hour of birth and those who were exclusively breastfed. Multivariate analyses revealed that continued BF at one and two years, and infants who were introduced to complementary foods had a higher prevalence of diarrhoea. EIBF and ExcBF were protective against diarrhoea in the regions of North, East and Central India. PBF, BotF and ISSSF were risk factors for diarrhoea in Central India. Continued BF at two years was a risk factor for diarrhoea in Western India. Findings suggested that EIBF and ExcBF were protective against diarrhoea in Northern, Eastern and Central India, while PBF, BotF, continued BF at two years and ISSSF were risk factors for diarrhoea in various regions in India. Improvements in IYCF practices are likely to reduce the burden of diarrhoea-related morbidity and mortality across regions in India

Factors associated with inadequate receipt of components and non-use of antenatal care services in India : a regional analysis

Background: Failure to use antenatal care (ANC) and inadequate receipt of components of ANC pose a significant risk for the pregnant woman and the baby. This study aimed to examine a regional analysis of factors associated with receiving no ANC and inadequate receipt of components of ANC services among Indian women. Method: Information from 173,970 women of reproductive age 15–49 years from the 2019–21 India National Family Health Survey (NFSH-5) was analysed. Logistic regression analyses that adjusted for cluster and survey weights were conducted to assess the socio-demographic and other factors associated with receiving non-use of ANC and inadequate receipt of components of ANC, respectively, in the six regions and 28 states, and 8 union territories in India. Results: Across regions in India, 7% of women reported no ANC, and the prevalence of inadequate and adequate receipt of components of ANC in all six regions ranged from 67 to 89% and 8% to 24%, respectively. Of all the 36 federated entities, the prevalence of inadequate receipt of ANC components was less than two-thirds in Tamil Nadu, Puducherry, Andaman and the Nicobar Islands, Odisha, and Gujarat. Our analyses revealed that associated factors vary by region, state, and union territories. Women from poor households reported increased odds of receiving no ANC in North, East and North-eastern regions. Women who reported no schooling in South, East and Central regions were associated with increased odds of receiving no ANC. Women from poor households in Himachal Pradesh, Bihar, Uttar Pradesh, Nagaland, Manipur, Uttar Pradesh, and Madhya Pradesh states reported significantly higher odds of inadequate components ANC than women from rich households. The receipt of inadequate components of ANC was significantly higher among women who never read magazines in Delhi, Ladakh, Karnataka, Telangana, Jharkhand, Maharashtra, Uttar Pradesh, Chhattisgarh, Arunachal Pradesh, Manipur, and Mizoram states in India. Conclusion: A better understanding of the factors associated with and incorporating them into the short- and long-term intervention strategies, including free financial support from the Indian government to encourage pregnant women from lower socioeconomic groups to use health services across all regions, states and union territories

Infant and young child feeding practices among adolescent mothers and associated factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India

Prevalence of key breastfeeding indicators in 29 sub-Saharan African countries : a meta-analysis of demographic and health surveys (2010– 2015)

Objectives: To carry out a meta-analysis to assess the prevalence of four key breastfeeding indicators in four subregions of 29 sub-Saharan African countries. Design, settings and participants The 29 countries were categorised into four subregions, and using cross-sectional data from the most recent Demographic and Health Surveys (2010–2015) of these countries prevalence of each of four key breastfeeding indicators was estimated for each of the subregions by carrying out a meta-analysis. Due to the presence of significant heterogeneity among the various surveys (I2>50%), a random-effect analytic model was used, and sensitivity analysis was performed to examine the effects of outliers. Main outcome variables: Early initiation of breast feeding, exclusive breast feeding, predominant breast feeding and bottle feeding. Results: The overall prevalence of early initiation of breast feeding varied between a lowest of 37.84% (95% CI 24.62 to 51.05) in Central Africa to a highest of 69.31% (95% CI 67.65 to 70.97) in Southern Africa; the overall prevalence of exclusive breast feeding ranged between a lowest of 23.70% (95% CI 5.37 to 42.03) in Central Africa to a highest of 56.57% (95% CI 53.50 to 59.95) in Southern Africa; the overall prevalence of predominant breast feeding ranged between a lowest of 17.63% (95% CI 12.70 to 22.55) in East Africa and a highest of 46.37% (95% CI 37.22 to 55.52) in West Africa; while the prevalence of bottle feeding varied between a lowest of 8.17% (95% CI 5.51 to 10.84) in West Africa and a highest of 30.05% (95% CI 28.42 to 31.69) in Southern Africa. Conclusions: West Africa and Central Africa recorded lower overall prevalence of early initiation of breast feeding and exclusive breast feeding than the WHO’s recommended target of 50% by the year 2025. Intervention for improved breastfeeding practices in sub- Saharan Africa should target West and Central Africa, while intervention to minimise bottle feeding should target Southern Africa

Methods of cultivation

This chapter deals with the various methods involved in the cultivation of the cotton crop. Methods involved in cotton cultivation include the method of land preparation, the different types of sowing methods, how fertilizer is managed, methods of protection of the cotton crop, as well as research advances in cotton cultivation

Prevalence of key breastfeeding indicators in 29 sub-Saharan African countries: a meta-analysis of demographic and health surveys (2010–2015)

Objectives: To carry out a meta-analysis to assess the prevalence of four key breastfeeding indicators in four subregions of 29 sub-Saharan African countries. Design, settings and participants The 29 countries were categorised into four subregions, and using cross-sectional data from the most recent Demographic and Health Surveys (2010–2015) of these countries prevalence of each of four key breastfeeding indicators was estimated for each of the subregions by carrying out a meta-analysis. Due to the presence of significant heterogeneity among the various surveys (I2>50%), a random-effect analytic model was used, and sensitivity analysis was performed to examine the effects of outliers. Main outcome variables: Early initiation of breast feeding, exclusive breast feeding, predominant breast feeding and bottle feeding. Results: The overall prevalence of early initiation of breast feeding varied between a lowest of 37.84% (95% CI 24.62 to 51.05) in Central Africa to a highest of 69.31% (95% CI 67.65 to 70.97) in Southern Africa; the overall prevalence of exclusive breast feeding ranged between a lowest of 23.70% (95% CI 5.37 to 42.03) in Central Africa to a highest of 56.57% (95% CI 53.50 to 59.95) in Southern Africa; the overall prevalence of predominant breast feeding ranged between a lowest of 17.63% (95% CI 12.70 to 22.55) in East Africa and a highest of 46.37% (95% CI 37.22 to 55.52) in West Africa; while the prevalence of bottle feeding varied between a lowest of 8.17% (95% CI 5.51 to 10.84) in West Africa and a highest of 30.05% (95% CI 28.42 to 31.69) in Southern Africa. Conclusions: West Africa and Central Africa recorded lower overall prevalence of early initiation of breast feeding and exclusive breast feeding than the WHO’s recommended target of 50% by the year 2025. Intervention for improved breastfeeding practices in sub- Saharan Africa should target West and Central Africa, while intervention to minimise bottle feeding should target Southern Africa

Population-attributable risk estimates for factors associated with inappropriate complementary feeding practices in The Gambia

Objective: The present cross-sectional study aimed to determine population-attributable risk (PAR) estimates for factors associated with inappropriate complementary feeding practices in The Gambia. Design: The study examined the first and most recent Demographic and Health Survey of The Gambia (GDHS 2013). The four complementary feeding indicators recommended by the WHO were examined against a set of individual-, household and community-level factors, using multilevel logistic analysis. PAR estimates were obtained for each factor associated with inappropriate complementary feeding practices in the final multivariate logistic regression model. Setting: The Gambia. Subjects: Last-born children (n 2362) aged 6–23 months. Results: Inadequate meal frequency was attributed to 20 % (95 % CI 15·5 %, 24·2 %) of children belonging to the youngest age group (6–11 months) and 9 % (95 % CI 3·2 %, 12·5 %) of children whose mothers were aged less than 20 years at the time of their birth. Inadequate dietary diversity was attributed to 26 % (95 % CI 1·9 %, 37·8 %) of children who were born at home and 20 % (95 % CI 8·3, 29·5 %) of children whose mothers had no access to the radio. Inadequate introduction of solid, semi-solid or soft foods was attributed to 30 % (95 % CI 7·2 %, 38·9 %) of children from poor households. Conclusions: Findings of the study suggest the need for community-based public health nutrition interventions to improve the nutritional status of Gambian children, which should focus on sociocultural and economic factors that negatively impact on complementary feeding practices early in infancy (6–11 months)

Determinants of suboptimal complementary feeding practices among children aged 6-23 months in seven francophone West African countries

Suboptimal complementary feeding practices play a crucial role in the health and development of children. The objective of this research paper was to identify factors associated with suboptimal complementary feeding practices among children aged 6-23 months in seven francophone West African countries, namely, Benin, Burkina Faso, Cote d'Ivoire, Guinea, Mali, Niger and Senegal. This study covered 22376 children aged 6-23 months from the seven countries surveyed (Benin: 3732 children; Burkina Faso: 4205 children; Cote d'Ivoire: 2109 children, Guinea: 1944 children, Mali: 3798 children, Niger: 3451 children and Senegal: 3137 children). The most recent Demographic and Health Survey datasets of the various countries were used as data sources. A set of individual-, household- and community-level factors were used to examine the four complementary feeding indicators. Multivariate analysis revealed that the youngest age bracket (6-11 months) of children, administrative/geographical region, mother's limited or non-access to the mass media, mothers' lack of contact with a health facility, rural residence, poor households and non-working mothers were the main factors associated with suboptimal complementary feeding in the countries surveyed. Our findings highlight the need to consider broader social, cultural and economic factors when designing child nutritional interventions

Determinants of suboptimal complementary feeding practices among children aged 6-23 months in four anglophone West African countries

Suboptimal complementary feeding practices have a detrimental impact on a child's growth, health and development in the first two years of life. They lead to child malnutrition, which contributes to the high prevalence of stunting (38%) and underweight (28%) reported for children <5 years of age in Sub-Saharan Africa. This study analysed complementary feeding practices in four anglophone West African countries (Ghana, Liberia, Nigeria and Sierra Leone) using the most recent Demographic and Health Surveys. The study covered 12623 children aged 6-23 months from four anglophone West African countries (Ghana: 822 children: Liberia: 1458 children, Nigeria: 8786 children and Sierra Leone: 1557 children). Four complementary feeding indicators were examined against a set of individual-, household- and community-level factors, using multiple regression analysis. Multivariate analyses found that lack of post-natal contacts with health workers, maternal illiteracy and geographical region were common determinants of delayed introduction of solid, semi-solid or soft foods across all four countries. Predictors for minimum dietary diversity, minimum meal frequency and minimum acceptable diet included children aged 6-11 months, administrative/geographical region, poorer household income and limited access to media. The authors recommend that the four anglophone West African countries studied should prioritise efforts to improve complementary feeding practices in order to reduce child morbidity and mortality. Interventional studies on complementary feeding should target those from poor and illiterate households