Predictors of complementary feeding practices in Afghanistan: Analysis of the 2015 Demographic and Health Survey.

Despite improvements over the past 20 years, high burdens of child mortality and undernutrition still coexist in Afghanistan. Global evidence indicates that complementary feeding (CF) practices predict child survival and nutritional status. Our study aims to describe CF practices in Afghanistan and to discern underlying predictors of CF by analysing data from Afghanistan's 2015 Demographic and Healthy Survey. Multilevel models were constructed comprising potential predictors at individual, household, and community levels and four CF indicators: timely introduction of solid, semi-solid, or soft foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) among breastfed children. INTRO prevalence among children aged 6-8 months was 56%, whereas the prevalence of MMF, MDD, and MAD among children aged 6-23 months was 55%, 23%, and 18%, respectively. Of the seven food groups considered, four were consumed by 20% or fewer children: eggs (20%), legumes and nuts (18%), fruits and vegetables (15%), and flesh foods (14%). Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators. Lower household wealth and lower community-level access to health care services were associated with lower odds of MDD and MAD. Disparities in achieving recommended CF practices were observed by region. CF practices in Afghanistan are poor and significant socioeconomic inequities in CF are observed across the country. Our study calls for urgent policy and programme attention to improve complementary feeding practices as an intrinsic part of the national development agenda

HOUSEHOLD FOOD INSECURITY ASSESSED BY THE FOOD ACCESS SURVEY TOOL (FAST) IN RURAL BANGLADESH AND MATERNAL AND INFANT NUTRITIONAL OUTCOMES

Background: Food security is a major concern in South Asia, where it coexists with the highest prevalence of maternal and child malnutrition in the world. The goal of this research was to investigate associations between household food insecurity (HFI), measured on a behavior-based scale, and both maternal diet and nutritional status during pregnancy and lactation and infant growth to 6 months of age in rural Bangladesh. Methods: Subjects were enrolled from November 2009 to June 2011 into a large cluster-randomized prenatal supplementation trial. Prospective dietary and nutritional status data from a cohort of 18,841 mothers and infants were collected from early pregnancy to 6 months postpartum. HFI was assessed using a 9-item Food Access Survey Tool (FAST), from which validity of using a summative index of its scores to reflect latent HFI was first established. Multivariate linear regression models of HFI, adjusting for maternal and household factors, were performed to explain associated variation in a) maternal dietary diversity, b) change in maternal weight and mid-upper arm circumference (MUAC) in pregnancy and lactation, and c) infant size at 6 months of age. Results: Half of the households were food insecure. The HFI index was dose-responsively associated with poorer antenatal and early postnatal dietary quality, especially reduced consumption in animal-source foods. While maternal size early in pregnancy and seasonality were strongly associated with the level of HFI, changes in neither maternal weight nor MUAC during pregnancy and lactation were correlated with HFI status. With poorer HFI, infant sizes at 6 months decreased progressively. Maternal nutrition at 1st trimester and infant size at birth together explained 57-89% of the infant size deficits associated with HFI at six months. Postnatal feeding, morbidity, and socio-economic status accounted for less than a third of the variability in infant size at 6 month explained by HFI. Conclusions: Widespread food insecurity persists in rural Bangladesh. In a large materno-infant cohort, we found evidence supporting strong and persistent nutritional consequences of food insecurity. Policies that address both food insecurity and reduce maternal and infant malnutrition should focus in women early in, and likely long before, pregnancy

Stagnating trends in complementary feeding practices in Bangladesh: An analysis of national surveys from 2004-2014.

Bangladesh has experienced steady socio-economic development. However, improvements in child growth have not kept pace. It is important to document complementary feeding (CF) practices-a key determinant of children's growth-and their trends over time. The study aims to examine trends in CF practices in children aged 6-23 months using data from Bangladesh Demographic and Health Surveys conducted in 2004, 2007, 2011, and 2014. Multilevel logistic regression models were applied to identify independent predictors of four CF practice indicators among children 6-23 months, namely, timely introduction of complementary foods, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. Introduction of complementary foods was achieved among 64-71% of children between 2004 and 2014. The proportion meeting minimum meal frequency increased from 2004 to 2007 (71-81%) and declined and held steady at 65% from 2011 to 2014. The proportion meeting minimum dietary diversity in 2011 and 2014 was low (25% and 28%), and so was minimum acceptable diet (19% and 20%). From 2007 to 2014, child dietary diversity decreased and the most decline was in the consumption of legumes and nuts (29% to 8%), vitamin A-rich fruits and vegetables (54% to 41%), and other fruits and vegetables (47% to 20%). Young child age (6-11 months), poor parental education, household poverty, and residence in the Chittagong and Sylhet independently predicted poorer feeding practices. Dietary diversity and overall diet in Bangladeshi children are strikingly poor. Stagnation or worsening of feeding practices in the past decade are concerning and call for decisive policy and programme action to address inappropriate child feeding practices

Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014.

There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6-23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO-UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community-level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children