COMPLEMENTARY FEEDING PRACTICES OF MOTHERS OF INFANTS AND YOUNG CHILDREN AND ITS DETERMINANTS IN DIFFERENT SOCIO ECONOMIC STRATA IN DELHI, INDIAKomal Rathi1, G.S Toteja2, Neena Bhatia11 Food and Nutrition Department, Lady Irwin College, University of Delhi, India.2 Division of Nutrition, Indian Council of Medical Research, New Delhi, India. Background: Optimum nutrition is indispensable for a childu2019s growth, health and behavioral development from birth to two years of age. Infant and young child feeding practices (IYCF) are an important determinant of nutritional status for a child.Aim: The study assessed the extent and pattern of complementary feeding practices of mothers of infants and young children, 6-23 months of age from different socioeconomic strata (SES) i.e. middle-income group (MIG), low-income group (LIG) and urban slums (US) in an urban area of Delhi. Methods: This is a cross-sectional study, being carried out on 600, mother-child dyads (infants and young children 6-23 months of age). IYCF practices were assessed using the World health organization (WHO, 2008) IYCF indicators. The study also determined the demographic and socioeconomic factors of complementary feeding practices. The association between maternal dietary diversity with child dietary diversity using the minimum dietary diversity tool for women (MDD-W) by FAO (Food and Agriculture organization) 2016 and minimum dietary diversity (MDD) indicator for infants and young children by WHO, 2008 was also explored.Results: Preliminary findings of the study have been shown for 101 mother-child pair (MIG-54, LIG-30, and US-17). The mean age of children was 14.3 months and that of mothers was 26.6 years. Mothers of children belonging to MIG had better IYCF practices as compared to LIG. The consumption of iron-rich or iron-fortified foods was found to be low among all SES (27.7%). Age of children was found to be significantly associated with achieving MDD and minimum meal frequency (MMF) (p
Complementary feeding, defined as the process of providing foods in addition to milk when breast milk or milk formula alone are no longer adequate to meet nutritional requirements, generally starts at age 6 months and continues until 23 months of age. This is a developmental period when it is critical for children to learn to accept healthy foods and beverages and establish long-term dietary patterns. It also coincides with the peak period for risk of growth faltering and nutrient deficiencies. This guideline provides global, normative evidence-based recommendations on complementary feeding of infants and young children 6–23 months of age living in low, middle- and high-income countries. It considers the needs of both breastfed and non-breastfed children. The guideline supersedes the earlier Guiding Principles for Complementary Feeding of the Breastfed Child and Guiding principles for feeding non-breastfed children 6-24 months of age. The recommendations in the guideline are intended for a wide audience, including policy-makers, and technical and programme staff at government institutions and organizations involved in the design, implementation and scaling of programmes for infant and young child feeding. The guideline may also be used by caregivers, health-care professionals, clinicians, academic and research institutions, and training institutions.
WHO and UNICEF jointly developed this global strategy to focus world attention on the impact that feeding practices have on the nutritional status, growth and development, health, and thus the very survival of infants and young children. The strategy is the result of a comprehensive two-year participatory process. It is based on the evidence of nutrition's significance in the early months and years of life, and of the crucial role that appropriate feeding practices play in achieving optimal health outcomes. The strategy is intended as a guide for action; it identifies interventions with a proven positive impact; it emphasizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities in this regards of governments, international organizations, and other concerned parties.
Appropriate nutrition during early life, coming mainly from adequate infant and young child feeding (IYCF) practices, is essential for optimal growth and development. This Data Note describes the trends and patterns in key IYCF practices and food consumption patterns among children, summarizing state and district data from the third and fourth rounds of National Family Health Surveys (2006 & 2016).
The complementary feeding period from 6 to 24 months is a crucial part of the first 1000 days of development. It marks the transition from exclusively milk-based liquid diet to the family diet and self-feeding. During this period, healthy food preferences and feeding practices are formed. The papers in this book were presented at the 87th Nestlé Nutrition Institute Workshop in Singapore, May 2016. Divided into three parts, they provide updates and recommendations, as well as insights into strategies and interventions, from all around the world. The first part addresses the role of complementary feeding in healthy development, focusing on food types and the timing of solid food introduction. The second part examines determinants of growth restriction and discusses effective interventions in infants and children in low- and middle-income countries. The last part focuses on development and 'programming' of behavioral and psychological aspects to prevent childhood obesity in high socioeconomic settings.
This review is intended primarily for health professionals and others concerned with nutrition, health and well-being of children. The objective is to provide the background information that is necessary for the development of scientifically sound feeding recommendations and appropriate intervention programmes to enhance children's dietary intake and nutritional status. Although much of the information may be relevent for young children in industrialized countries, the review focuses on the particular needs of children in low-income sttings, and the recommendations hve been formulated with consideration for the economic and environmental constraints that are common in developing countries. [Author] The review is organized in nine sections : 1. Introduction. - 2. Breast-feeding and complementary feeding : a continuum. - 3. Energy required from complementary foods and factors affecting their intake. - 4. Protein and micronutrients required from complementary foods. - 5. Caregiver feeding behaviours. - 6. Food processing safety and quality. - 7. Global data on child-feeding practices. - 8. Programmatic interventions to improve complementary feeding. - 9. Conclusions
Complementary feeding refers to the introduction of foods other than human milk or formula to an infants diet. In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children. The interventions studied took place in the U.S. and other high-income country health care systems; early care and education settings; university cooperative extension programs; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); home visiting programs; and other settings. This consensus study report summarizes evidence and provides information on interventions that could be scaled up or implemented at a community or state level.
The World Health Organisation (2016) recommends exclusive breastfeeding up to 6 months of age and the introduction of complementary foods at around 6 months. International literature suggests that although knowledge of the guidelines is high, only a minority of parents wait until 6 months to wean and sub-optimal weaning practices are common. The aim of this study was to assess breastfeeding and weaning practices and to evaluate the effect of socio-economic determinants on such behaviours in a Mediterranean setting.A cross-sectional study design was used. One-time short interviews with 250 consenting mothers having 8 month old infants were conducted using a structured questionnaire. Mothers attending all the well baby clinics in the primary health care centres of the Maltese Islands for a period of two months were included in the study. The questionnaire included socio-economic and demographic data, details on the initiation and duration of breastfeeding, weaning practices and a short assessment of the infantu2019s usual diet at 8 months.Mothers between 25-34 years old (26%) and mothers with a high level of education (25%) were more likely to breastfeed only during the first 8 months of life without using any other type of milk, compared to younger (6.5%) or older (21%) mothers, and to mothers with a lower level of education (16%). The level of education was also positively associated with the continuation of breastfeeding, with the mean duration of breastfeeding for higher educated mothers being 4 months compared to 2.6 months in less educated mothers. Mothers with a lower level of education and mothers who are house-wives are more likely to give their infants only ready-made foods however associations were in this case borderline significant. On the other hand, appropriateness of weaning age was not associated with any socio-economic factors.The length of breastfeeding and the introduction of complementary foods varied widely between mothers. Compliance with infant feeding guidelines was poor. The motheru2019s age, level of education and employment status all have an impact on breastfeeding and weaning practices. The provision of professional advice and a supportive environment for mothers, together with interventions for increasing awareness may promote maternal adherence to WHO guidelines.
The prevalence of stunting (30%) and wasting (9%) among children under the age of five years (U5) in Guinea have seen little decline in the past decade. One contributor to the high prevalence of stunting and wasting among children U5 is poor diet quality. In 2018, less than half of children 6 -- 23 months consumed the recommended food groups (15%) and meals (25%) per day to meet their nutrient requirements. However, there has been little qualitative or quantitative research conducted over the past decade to explore the multilevel determinants of infant and young child (IYC) diets and growth outcomes in Guinea. The United Nations Children's Fund (UNICEF) conceptual framework theorizes the immediate (diet, care), underlying (food, practices, services), and enabling determinants (resources, norms, governance) determinants of maternal, infant, and young and child nutrition (MIYCN). However, the UNICEF framework does not provide a robust model for exploring the factors shaping IYC diets, an immediate determinant of nutritional status. However, the Ecological Model of Food and Nutrition (EMFN) has been used for over 50 years to explore the various factors influencing diets across contexts. In addition to immediate determinants such as diet, caregiver feeding style is an underlying determinant of IYC diets and nutritional status. However, there has been little work conducted across low-and-middle income-countries including Guinea to understand the relationship between caregiver feeding styles and IYC dietary quality. Finally, enabling determinants including programs and policies are upstream factors that shape IYC diets and nutritional status. UNICEF recommends intervening through water, sanitation, and hygiene (WASH), social protection, food, and health systems to improve IYC diets and growth outcomes. However, to our knowledge, no study has systematically explored what evidence-based program modalities across systems are being supported by policies or programs in Guinea. To better understand key immediate, underlying, and enabling determinants of IYC nutritional status, this study sought to explore the infant feeding practices and inform strategies to improve MIYCN in Guinea. To fill this research gap, our first study sought to understand what factors are associated with infant dietary diversity score (DDS) in Forécariah, Guinea. To assess and define factors that shape infant DDS, a dietary assessment and survey were administered to caregivers of indexed infants (6 -- 9 months). Then, to understand the factors shaping infant diets, 3-hour observations were conducted among indexed infants (n = 81) and interviews were conducted with caregivers (n = 34) and community leaders (n = 13). A stepwise linear regression was used to understand what factors were significantly associated with infant DDS. Textual data were then analyzed deductively using the EMFN to understand how different factors shape the feeding practices of caregivers who fed infants a more diverse diet from those who did not. Findings from our study revealed that food insecurity, maternal time, and feeding advice received through various channels (i.e., radio, interpersonal) shape caregiver feeding behaviors and infant diet. Factors found to be positively associated with infant dietary diversity scores include having access to water in the household, feeding infants the same foods as primary caregivers weekly, owning land for homestead food production, and infant age. Conversely, adhering to food taboos was negatively associated with infant dietary diversity score. Imported foods were symbolized as 'clean' and locally sourced foods were symbolized as 'unclean' caregivers who fed less diverse diets. Our second study sought to understand what caregiver feeding styles are being employed by indexed caregivers and how they relate to infant DDS in Forécariah, Guinea. To define caregiver feeding styles we carried out 3-hr observations of indexed infants (n = 81), Then, to understand how and why caregivers were employing these feeding styles we carried out interviews among a subset of indexed caregivers (n = 34). Quantitative data from direct observations were subjected to k-medoid cluster analysis and textual data were analyzed using content analysis. Findings from our study revealed that three distinct feeding styles were being employed in Forécariah, Guinea including responsive, forceful, and uninvolved. Most caregivers in our sample carried out responsive feeding behaviors but fed their infants the least diverse diets. Drivers of responsive, forceful, and uninvolved feeding styles included maternal time, caregiver trust in the infant's hunger and satiety cues, and cues associated with an infant being developmentally ready to self-feed, respectively. Our third study sought to understand how current policies and programs can be leveraged to improve MIYCN in Guinea. To understand the current policy and program environment, we conducted a narrative literature review of operating programs (i.e., 2019-2022) and policies across systems. Then, to understand what factors shape program implementation, we conducted semi-structured interviews with stakeholders (n = 20) across systems. Textual data were analyzed using a content analysis approach guided by the UNICEF systems framework and a nutrition implementation science framework. Findings revealed that most evidence-based program modalities across systems were being cited in policy (25/32) and program documents (28/32). Salient factors identified to be shaping programs during interviews included poor policy development, suboptimal funding, variable stakeholder technical knowledge, low provider-to-beneficiary ratios, substandard program planning, scale-up, and resources at the community level. However, the most salient factor discussed across domains was programming planning and scale-up which was namely due to duplication of activities, poor supply chains, funding-related constraints, and suboptimal integration of activities across systems and within systems. Findings from our study suggest that multilevel determinants shape infant diets in Forécariah but also MIYCN in Guinea at large. Food taboos identified in this study and intervention approaches that have been successful in shifting social norms in other contexts could be used to dismantle food taboos and improve infant DDS in Forécariah, Guinea. Findings from this research also indicate that policymakers in Guinea may also consider introducing guidelines against advertising of IYC foods in line with WHO guidance to improve infant DDS. Findings from our second study could be used to generate tailored messaging to encourage caregivers to feed responsively during mealtimes. Finally, findings from our third study could be used as a guide for stakeholders across systems in Guinea to leverage the integration of currently operating programs to improve MIYCN using a multisectoral approach.
