File Name: trends and predictors of appropriate complementary feeding practice dhs .zip
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Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey — These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan.
This consequently reduces premature mortality and undernutrition. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests: The authors have declared that no competing interests exist. Undernutrition is the leading cause of under-five mortality around the world.
Inadequate infant and young child feeding IYCF practices are the major determinants of undernutrition, optimal growth, and development, especially in the first two years of life [ 1 ]. Exclusive breastfeeding provides necessary nutrients and energy to the child, especially in the first six months of life [ 2 ]. However, as the child grows older, exclusive breastfeeding is no longer sufficient for adequate levels of energy and nutrients for the child. Therefore, the World Health Organization WHO recommends the introduction of appropriate complementary foods with breastfeeding after six months of birth [ 3 ].
Consumption of complementary solid, semi-solid, or soft foods with breastfeeding contributes to the healthy development of a child after the age of six months [ 4 ].
In addition, WHO recommends the adequate consumption of iron-rich food and a diversified diet with minimum recommended frequency. While complementary food replaces breastmilk, if the food is of low nutrient density, it leads to micronutrient deficiency and increased incidence of diarrhea, particularly for children between the ages of 6 and 12 months [ 5 ]. Moreover, interventions related to improvement in food intake after two years of life do not have a significant relationship with nutritional outcomes [ 6 ].
Globally, about one-third of the under-five deaths are attributable to undernutrition, with the majority of these deaths recorded in Asia [ 9 ]. About Malnutrition is responsible for sixty percent of the annual under-five deaths in developing countries [ 11 ].
South Asia bears a disproportionally high burden of malnutrition relative to other regions with the highest percentages of stunting Infant and child mortality rates in Pakistan are among the highest in the world at 62 infant deaths and 74 child deaths per live births in [ 13 ].
Pakistan is also the worst performer in terms of the prevalence of malnutrition in the world. Within South Asia, the stunting and wasting rates in Pakistan Rural areas bear a significantly high burden of malnutrition compared to the urban areas with 2. Similarly, the poor-rich divide is also quite evident; for instance, stunting, underweight, and wasting rates are significantly higher for children in the lowest wealth quintile compared to the children in the highest wealth quintile two times, four times, and three times higher, respectively.
Recent studies have shown that inadequate food consumption is one of the main determinants of stunting in Pakistan [ 14 , 15 ]. One exception is Na et al. However, their study is based on eight years old data, and their analyses do not differentiate between urban and rural areas. Therefore, the objectives of this study are to provide fresh evidence on the geographical distribution of child feeding practices in Pakistan at national, urban, and rural levels and to examine the relationship of child feeding practices with individual-, household-, and community-level indicators using the latest nationally representative data from Pakistan Demographic and Health Survey, —18 [ 13 ].
Existing literature on the determinants of child feeding practices, including minimum dietary diversity and meal frequency, has shown that feeding practices are correlated with maternal education, maternal occupation, the gender of the child, and postnatal care [ 11 ].
Moreover, place of residence, household size, household wealth, age of the child, and place of delivery are also among the significant correlates of child feeding practices [ 17 — 19 ]. The variables used in this analysis are guided by the studies mentioned above.
A nationally representative sample of 16, households is selected from women in the age group of 15—49 years. Stratified sampling was carried out for PDHS —18 in two stages. In the first stage, Primary Sampling Units PSUs were selected based on probability proportional to the primary sampling unit size clusters were selected. In the second stage of selection, a fixed number of 28 households was randomly drawn from every cluster by using an equal probability systematic sampling procedure.
Since complementary foods are recommended after six months of life, the analysis is restricted to children between the ages of 6 and 23 months. Minimum dietary diversity is based on the WHO recommendation of consuming at least four food groups out of seven to provide necessary nutrients and energy for the child to ensure normal growth. PDHS does not ask for the quantity consumed from each food group, i.
Minimum meal frequency is defined as the proportion of children between 6—23 months of age breastfed or otherwise who received solid, semi-solid, or soft foods for at least the minimum number of times recommended by WHO.
For non-breastfed children, milk is also considered in calculating the minimum food-frequency. Breastfed children between 6 and 8 months of age and between 9 and 23 months of age should consume solid or semi-solid food minimum twice a day and thrice a day, respectively.
Non-breastfed children between 6 and 23 months of age should consume solid or semi-solid food at least four times a day, and also, they should intake dairy or formula milk. A minimum acceptable diet is a combination of diet diversity and meal frequency variables where a breastfed child 6—23 months of age is considered to be receiving a minimum acceptable diet if he had at least the minimum dietary diversity and meal frequency in the last 24 hours.
Similarly, a non-breastfed child 6—23 months of age is considered to be receiving a minimum acceptable diet if he has received at least two milk feedings with minimum dietary diversity excluding milk and minimum meal frequency in the last 24 hours. For ease of interpretation, the explanatory variables are grouped into three categories: individual-, household-, and community-level indicators. The wealth index was generated using principal component analysis on the following indicators: accessibility to electricity; ownership of a radio, refrigerator, bicycle, motorcycle, car; no.
Three complementary feeding indicators minimum dietary diversity, minimum meal frequency, and minimum acceptable diet were examined against a set of independent variables divided into three groups as explained above to identify the factors associated with child feeding practices in Pakistan. Statistical analyses were performed using Stata version Final models are further tested for multicollinearity, and variables with Variance Inflation Factor VIF greater than five were excluded from the final model.
After data cleaning and selection of relevant age-specific cases, the weighted sample size of this analysis is 2, children in communities. Sample characteristics by individuals, households, and community are presented in Table 1. Source: Author using DHS —18 data.
The percentage of children satisfying minimum meal frequency shows an inverted u-shaped relationship with age as meal frequency increases when a child moves from the age group of 6—11 months to 12—17 months, but it decreases again when the child moves to 18—23 months age group. Among individual-level characteristics, child age is a significant predictor of minimum dietary diversity.
Children who had above average weight at birth and who took vitamin A supplements in the last six months have higher odds of meeting diet diversity, both in the full sample and rural areas. Children who received age-appropriate vaccinations have higher odds of meeting diet diversity in urban areas [1. Among household characteristics, lower wealth status has lower odds of compliance with dietary diversity in the full sample and rural regressions.
In overall and urban regressions, children in households headed by male members are more likely to consume a diversified diet. In rural regressions, households using unimproved water source reference: piped water [0. Among community characteristics, a higher proportion of at least four prenatal visits at the community level is associated with higher odds of dietary diversity compliance in all three regressions, whereas postnatal checkups were only significant in urban regression [1.
The use of improved water and sanitation assisted delivery, and age-appropriate vaccinations have lower odds of meeting dietary diversity, which is against our expectations. The adjusted odds of factors associated with minimum meal frequency for overall, rural and urban samples are presented in Table 4. Among individual-level characteristics, male children, children aged 12—17 months, and those with average or larger than the average size at birth have higher odds of receiving adequate meal frequency.
Gender and birthweight are insignificant in urban regressions. In urban and rural regressions, mothers older than 20 years are associated with higher odds of meal frequency compliance in both urban and rural regressions. Among household characteristics in urban areas, the use of efficient fuel is associated with higher odds of meeting minimum meal frequency [1.
Among community characteristics, postnatal checkups and age-appropriate vaccinations at the community level have higher odds of a child receiving minimum meal frequency in overall and urban regressions. In rural regressions, at least four prenatal visits have three-fold higher odds of meal frequency compliance [3.
In urban regressions, the percentage of cesarean deliveries have lower odds [0. Among individual-level characteristics, children between 6—11 months of age, who are born in fifth or higher-order, who were larger than average in size at birth, and those who received vitamin A supplements in the past six months have higher odds of receiving minimum acceptable diet, whereas those who had a fever in past two weeks have lower odds of receiving minimum acceptable diet.
Birth order is insignificant in rural regressions, and vitamin A supplementation is insignificant in urban regressions. Among parent characteristics, mothers younger than 25 years, who work in the non-agricultural sector, who read newspapers or magazines, and who had cesarean delivery have higher odds of meeting minimum acceptable diet requirements.
Children of fathers who have at least primary education have twice the odds of receiving a minimum acceptable diet [2. Among household characteristics, children who live in households that use efficient fuel for cooking full sample , improved water full sample , or have a male head of the household full and urban sample have higher odds of meeting minimum acceptable diet. In rural regressions, household size between 6—9 members is associated with lower odds [0.
Among community characteristics, utilizing improved water full and urban sample and improved sanitation full and rural sample have lower odds of meeting minimum acceptable diet. In this study, we examined the factors associated with minimum dietary diversity, minimum meal frequency, and minimum acceptable diet among children between 6 and 23 months of age in Pakistan by using the most recent nationally representative data from Demographic and Health Survey, — About a quarter of the children met diet diversity criteria, two-fifth met minimum meal frequency criteria, and, marginally, more than one in ten children met the minimum acceptable diet criteria.
Poor dietary intake among children in Pakistan is, therefore, a serious concern as consumption of a diversified diet is associated with adequate micronutrient intake and a lower risk of stunted growth among children in developing countries [ 26 — 28 ]. All food groups, except Legumes and Nuts, show an increase in consumption with age, which contradicts the hypothesis of substitution among food types across age groups in the recent study on Pakistan Na et al.
Legumes and Nuts, and Dairy products are among the least consumed food groups. The least consumed food groups in Pakistan are essential for fatty acids, micronutrients, bioactive compounds, foods sourced from animals for improved digestibility, which are necessary for optimal child development [ 30 , 31 ].
Low dairy consumption among non-breastfed children in Pakistan is surprising because Pakistan is the 4 th largest milk producer in the world, and milk is the main livestock commodity, the growth of which has been increasing [ 32 ]. Moreover, the consumption of dairy products is not correlated with livestock ownership. The possible reasons could be that the poor livestock owners use milk for their livelihood instead of feeding their children.
It is also possible that mothers are not aware of the importance of feeding dairy products to their children. The results of multivariate regression analysis show that children in the age group of 6—11 months have higher odds of achieving minimum diet diversity and minimum acceptable diet than children in the older age groups. Our findings are in line with previous studies in Bangladesh [ 33 ], Sri Lanka [ 34 ], and Pakistan [ 29 ].
The adjusted odds associated with child-age are higher in rural areas. Perceived child weight at birth is also associated with adequate child feeding practices; children who were of average or above-average size at birth have higher odds of receiving minimum diet diversity, meal frequency, and acceptable diet. Child weight is not significantly correlated with minimum dietary diversity in urban areas suggesting that diet patterns do not vary by the weight of a child at birth in urban areas.
It could be because of the belief that a child with a smaller than the average size at birth may not digest several types of foods [ 29 ]. Adjusted odds ratios show that children of older mothers have lower odds of receiving recommended diet, and it may be explained by the willingness of young mothers to comply with the recommendations of modern research, and they may not subscribe to the erroneous cultural beliefs as strongly as the older mothers do.
Also, reading a newspaper or a magazine is positively correlated with minimum dietary diversity and acceptable diet in the full sample and urban sample, whereas it is only significant for minimum meal frequency in the urban sample. Nevertheless, increasing access to the newspaper can improve complementary feeding in Pakistan.
Similar findings were reported by Na et al. Among household-level characteristics, the wealth of the household is a significant predictor of minimum dietary diversity, and gender of the household head is a significant predictor of dietary diversity and minimum acceptable diet among children between 6—23 months of age, except in rural areas.
Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey — These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan. This consequently reduces premature mortality and undernutrition.
Metrics details. Poor complementary feeding of children aged 6—23 months contributes to the characteristics negative growth trends and deaths observed in developing countries. Evidences have shown that promotion of appropriate complementary feeding practices reduces the incidence of stunting and leads to better health and growth outcome. This study was aimed at assessing practices of complementary feeding and associated factors among mothers of children aged 6—23 months. A community-based cross sectional study design was conducted among mothers who had children with 6—23 months of age in the ten randomly selected Kebeles smallest administrative unit. A multistage sampling technique was used to identify study subjects.
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 Demographic and Healthy Survey. Increasing child age and more antenatal care visits were significantly and positively associated with greater odds of meeting all CF indicators.
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: September 22, Published: October 23,
Stunting is a major public health problem in most developing countries, and it increases the risk of illness and death throughout childhood. It is also a major public health problem in Ethiopia. Most of the few studies done in Ethiopia were done in schools. However, the prevalence of stunting of school-age children at the community level is largely unknown. To assess prevalence and predictors of stunting among school-age children in Mecha District, Amhara Regional State, Ethiopia. A community-based cross-sectional study was conducted from August 28, , to October 10,
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