Determinants of Complementary Feeding Practices Among Nepalese Children Aged 6-23 Months: Findings From Demographic and Health Survey 2011

Background: The adoption of inappropriate feeding practices is one of the reasons for under nutrition in Nepal and elsewhere. The objective of this study was to describe the rate of and identify the factors associated with providing the World Health Organization (WHO) recommended infant feeding practices of minimum dietary diversity, minimum meal frequency and minimum acceptable diet in Nepal amongst young children between 6–23 months in 2011. Methods: Data from Nepal Demographic and Health Survey (NDHS) 2011 was used. Prevalence of minimum dietary diversity, minimum meal frequency and minimum acceptable diet was obtained by using descriptive statistics. A Chi-square test (χ2) followed by multiple logistic regression analyses were used to determine the adjusted effect of potential factors on the outcome variables. Results: Of the 698 children aged 6–23 months; while 535 (76.6%) received the minimum meal frequency, only 212 (30.4%) children received the minimum dietary diversity, and 185 (26.5%) received an acceptable diet. Children of older mothers (>35 years); educated mothers and fathers; and mothers from all the development regions except the Mid-western region were more likely to have been provided with the recommended dietary diversity. Children of mothers who had attended ≥4 antenatal visits and who lived in the Eastern region were more likely to provide their child with the recommended meal frequency. Children of mothers, who attended ≥ 4 antenatal visits, were educated and whose fathers had at least a secondary education were more likely to meet the recommended acceptable diet standards.Conclusion: Young children aged less than two years in Nepal are at risk for not meeting the WHO recommended infant feeding standards given that only about one in three children were provided with the recommended dietary diversity and acceptable diet. This finding suggests that the majority of children are at risk of under nutrition. An appropriate mix of health education and food supplements could be a feasible option for Nepal to improve the number of children who meet the recommended infant feeding guidelines, reduce under nutrition and improve the survival rates of young children

The nutritional status of children in Bhutan: results from the 2008 National nutrition survey and trends over time

<p>Abstract</p> <p>Background</p> <p>There are few reports on the nutritional status of Bhutanese children. The objective of this paper is to summarize results from the 2008 National Nutrition Survey and to describe progress achieved during the last two decades.</p> <p>Methods</p> <p>A cross-sectional survey of 2376 children aged 6 to 59 months was conducted during November-December 2008 to provide national and regional estimates. A multi-stage cluster sampling method was applied and 40 gewogs/thromdes were selected from each region (Western, Central, Eastern). Guidelines on how to measure length/height and weight followed WHO standardized procedures. Data were analysed for consistency and validation using the software WHO Anthro and the WHO SPSS macro. Underweight, stunting, overweight, wasting and thinness were defined based on the WHO Child Growth Standards. Data from 1986-88 and 1999 national surveys were reanalysed using the WHO standards to describe trends in nutritional status.</p> <p>Results</p> <p>Nationally, 34.9% Bhutanese preschool children are stunted and 10.4% are underweight. Wasting is 4.7%, with severe wasting close to 2% in rural areas, while overweight affects 4.4% of preschool children. While underweight rates are similar across regions, wasting is substantially more prevalent in the Western region and stunting in the Eastern region. Stunting shows a steep rise during the first two years of life, as high as 40%, and levels off thereafter, while wasting is greatest among children aged 6-24 months and subsequently decreases. The prevalence of stunting fell from 60.9% in 1986-88 to 34.9% in 2008, and underweight declined from 34.0% to 10.4% during same period. The percentage of wasted children dropped from 5.2% in 1986-88 to 2.5% in 1999 but then increased to 4.7% in 2008.</p> <p>Conclusions</p> <p>There have been major improvements in the nutritional status of Bhutanese children over the past two decades, however, linear growth retardation remains a significant concern. Early identification of growth faltering is essential for improving the effectiveness of public health programs to prevent stunting. Similarly, wasting rates indicate the need for a system to identify children with severe malnutrition in the isolated communities so that they can receive appropriate care.</p

Implications of methodological differences in measuring the rates of exclusive breastfeeding in Nepal: findings from literature review and cohort study

BACKGROUND: Correct measurement and continuous monitoring of exclusive breastfeeding are essential to promote exclusive breastfeeding. Measuring exclusive breastfeeding is a complex issue as rates can vary according to the definition, measurement period, questions asked, and infant's age. This article reviewed the methodology of reporting exclusive breastfeeding in Nepal, and compared exclusive breastfeeding rates using data from a cohort study undertaken in western Nepal. METHODS: A literature review was first conducted on studies published during 2000-2014. In our cohort study, 735 mother-infant pairs were recruited within the first month postpartum and followed up during the fourth and sixth months. RESULTS: The majority of studies in Nepal, including national surveys, used the World Health Organization (WHO) recommended definition (only breastmilk with the exception of medicine and vitamin syrup), and the most common measurement period was a 24-h recall. Our data demonstrated that the exclusive breastfeeding rate during the sixth month was 8.9% using the recall-since-birth method but was 18.7% using the 24-h recall method. Substantial differences in rates were also found during the first (66.3% vs 83.9%) and fourth months (39.2% vs 61.1%). CONCLUSION: We found that recent studies reporting exclusive breastfeeding in Nepal varied considerably in methodology. The most commonly used measurement, the 24-h recall, leads to over-estimation of the prevalence of exclusive breastfeeding when compared to the recall-since-birth method. A common standard of reporting exclusive breastfeeding is clearly needed for evidence-based decision making