Contextualising complementary feeding in a broader framework for stunting prevention

Abstract

An estimated 165 million children are stunted due to the combined effects of poor nutrition, repeated infection and inadequate psychosocial stimulation. The complementary feeding period, generally corresponding to age 6-24 months, represents an important period of sensitivity to stunting with lifelong, possibly irrevocable consequences. Interventions to improve complementary feeding practices or the nutritional quality of complementary foods must take into consideration the contextual as well as proximal determinants of stunting. This review presents a conceptual framework that highlights the role of complementary feeding within the layers of contextual and causal factors that lead to stunted growth and development and the resulting short-and long-term consequences. Contextual factors are organized into the following groups: political economy; health and health care systems; education; society and culture; agriculture and food systems; and water, sanitation and environment. We argue that these community and societal conditions underlie infant and young child feeding practices, which are a central pillar to healthy growth and development, and can serve to either impede or enable progress. Effectiveness studies with a strong process evaluation component are needed to identify transdisciplinary solutions. Programme and policy interventions aimed at preventing stunting should be informed by careful assessment of these factors at all levels.

Context-specific complementary feeding recommendations developed using Optifood could improve the diets of breast-fed infants and young children from diverse livelihood groups in northern Kenya

“…nutrients likely to remain low in IYC diets based on local food sources, as consumed); (ii) the best available food sources to fill nutrient gaps; and (iii) alternative CFR for 7 d diets that would improve dietary adequacy for eleven nutrients (Ca, Fe, Zn, riboflavin, niacin, thiamin, folate and vitamins A, B 6 , B 12 and C). These alternative CFR were then tested, in Optifood, to select the best sets of CFR, using criteria based on predicted population-level nutrient adequacy and minimum diet cost.…”

“…REGAL-IR interventions support local structures to improve the social, economic and environmental conditions that contribute to nutritionally inadequate infant and young child (IYC) diets and high rates of child stunting (6,7) . At the same time, the project aims to improve nutrition outcomes through complementary feeding behaviour change interventions.…”

What would it take to prevent stunted growth in children in sub-Saharan Africa?

“…The environment in which the child is born is critical in shaping their growth and development. Stewart et al (14) identified proximal factors that contribute to stunted growth which include household and family factors, breastfeeding practices, complementary feeding practices and infections. With regard to household factors maternal education is very important.…”

Maternal perception of sickness as a risk factor of stunting in children aged 2-5 years

“…(25) The risk factors that were investigated in this study were only socio-cultural factors, namely factors that only indirectly cause stunting. On the other hand, there are still many other factors with a direct influence on stunting, such as dietary intake and infectious disease.…”