Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries

Osendarp, Saskia; Broersen, Britt; Liere, Marti van; De-Regil, Luz María; Bahirathan, Lavannya; Klassen, Eva; Neufeld, Lynnette M.

doi:10.1177/0379572116655239

Cited by 54 publications

(55 citation statements)

References 38 publications

(134 reference statements)

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“…In models controlling for demographic characteristics, maternal CHW exposure and child’s dietary diversity, we found that children who consumed MNP had a significantly higher mean hemoglobin levels and a lower risk of anemia. A recent study which pooled dietary data from 15 studies in low-resource settings found that complementary feeding diets were consistently inadequate in several micronutrients, and that even when the researchers optimized children’s diets with modelling techniques, intake of several micronutrients remained inadequate [30]. In many settings—including in our Madagascar sample where dietary diversity remained below the recommended four food groups for the majority of children—interventions focusing on behavior change communication strategies promoting consumption of local complementary foods may not be sufficient to address the micronutrient gap.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6–23 Months in Madagascar

Locks

Reerink

Brown³

et al. 2017

Nutrients

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This study assesses the impact of an integrated infant and young child feeding (IYCF) and micronutrient powder (MNP) intervention on children’s risk of anemia and IYCF practices in Madagascar. Quantitative baseline and endline surveys were conducted in representative households with children 6–23 months from two districts, where an 18-month IYCF-MNP intervention was implemented. Relative risks comparing children’s risk of anemia and maternal IYCF knowledge and practices at baseline versus endline, and also at endline among MNP-users versus non-users were estimated using log-binomial regression models. 372 and 475 children aged 6–23 months were assessed at baseline and endline respectively. Prevalence of anemia fell from 75.3% to 64.9% from baseline to endline (p = 0.002); the reduction in the risk of anemia remained significant in models adjusting for sociodemographic characteristics (ARR (95% CI): 0.86 (0.78, 0.95), p = 0.003). In endline assessments, 229 out of 474 (48.3%) of children had consumed MNPs. MNP-users had a lower risk of anemia (ARR (95% CI): 0.86 (0.74, 0.99), p = 0.04) than non-users, after controlling for child’s dietary diversity and morbidity, maternal counseling by community-health-workers, and sociodemographic characteristics. Mothers interviewed at endline also had greater nutrition knowledge and were more likely to feed their children ≥4 food groups (ARR (95% CI): 2.92 (2.24, 3.80), p < 0.001), and the minimum acceptable diet (ARR (95% CI): 2.88 (2.17, 3.82), p < 0.001) than mothers interviewed at baseline. Integration of MNP into IYCF interventions is a viable strategy for improving children’s consumption of micronutrients and reducing risk of anemia. The addition of MNP does not negatively impact, and may improve, IYCF practices.

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Section: Discussionmentioning

confidence: 99%

The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6–23 Months in Madagascar

Locks

Reerink

Brown³

et al. 2017

Nutrients

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“…Compared with other interventions, food fortification may be more cost‐effective—and, if fortified foods are regularly consumed, has the advantage of maintaining steady body stores . However, infants and young children, owing to their smaller stomach sizes, can usually not consume enough of fortified family foods to match their dietary requirements, and therefore targeted special fortified infant or complementary foods will be required for this age group …”

Section: Successful Infant and Young Child Feeding Programs In Indiamentioning

confidence: 99%

Dietary and nutritional change in India: implications for strategies, policies, and interventions

Shankar

Agrawal

Beaudreault

et al. 2017

Annals of the New York Academy of Sciences

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Despite the global transition to overnutrition, stunting affected approximately 159 million children worldwide in 2014, while an estimated 50 million children were wasted. India is an important front in the fight against malnutrition and is grappling with the coexistence of undernutrition, overnutrition, and micronutrient deficiencies. This report summarizes discussions on trends in malnutrition in India, its evolution in the context of economic growth, intrahousehold aspects, infant and young child feeding practices, women's status, maternal nutrition, and nutrition policymaking. The discussion focuses on a review of trends in malnutrition and dietary intakes in India in the context of economic change over the past four decades, identification of household dynamics affecting food choices and their consequences for family nutritional status in India, and effective malnutrition prevention and treatment interventions and programs in India and associated policy challenges.

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“…When using linear programming and a series of assumptions related to affordability and acceptability, the use of local foods to increase quality and nutrient density can be improved. A recent review of such studies (5) showed that, even when the use of local ingredients could be optimized, it was difficult to meet requirements for some nutrients, such as iron and zinc, under economic and availability constraints. In such contexts, the WHO and others recommend that children should receive fortified complementary foods (FCFs) 6 or nutrient supplements to address these dietary gaps (1).…”

Section: Introductionmentioning

confidence: 99%

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries

et al. 2017

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Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking.Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries.Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices.Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand.Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

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Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries

Abstract: Our findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.

Cited by 54 publications

References 38 publications

The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6–23 Months in Madagascar

The Impact of Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention on Feeding Practices and Anemia in Children Aged 6–23 Months in Madagascar

Dietary and nutritional change in India: implications for strategies, policies, and interventions

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries

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