Determinants of infant and young complementary feeding practices among children 6–23 months of age in urban Pakistan: a multicenter longitudinal study

Abstract

Background Suboptimal feeding practices have a negative impact on children’s health and growth in the first 2 years of life and increase their risk of undernutrition, morbidity, and mortality. The aim of the study was to assess the factors that influence infant and young child feeding practices among urban mothers in a hospital setting at Karachi, Pakistan. Methods A longitudinal multi-center cohort study was conducted in four countries, MULTICENTER BODY COMPOSITION REFERENCE STUDY (MBCRS) to produce normal body composition reference data in healthy infants from 3 months to 24 months of age. Repeated anthropometric (weight, length and head circumference) and body composition measurements using “deuterium dilution method” along with 24-h dietary recall questionnaires were performed on 250 healthy term infants at 3, 6, 9, 12, 18, and 24 months of age. The 24-h dietary recall data from this study was used to assess the breastfeeding and complementary feeding practices in children aged 6–24 months. Results A total of 250 healthy infants were enrolled in the study. A majority of newborns (75.4%) were exclusively breastfed till 3 months of age; however, by 6 months of age, only 30.2% of infants were exclusively breastfed. Only 44.1% of children aged 6–24 months achieved minimum dietary diversity (MDD), 84.7% achieved minimum meal frequency (MMF), and 44.1% achieved a minimum acceptable diet (MAD). 71.4% achieved MDD and MAD and 100% achieved MMF at 24 months. The bivariate analysis found that breastfed children (OR 3.93, 95% CI 2.72–5.68), with employed mothers (OR 1.55, 95% CI 1.06–2.27) who had graduated from secondary school (OR 1.45, 95% CI 1.08–1.94) were more likely to meet minimum dietary diversity. The multivariable analysis showed that only the child’s age was significantly associated with MDD (p value< 0.0001), with the likelihood of meeting MDD increasing as the children aged; 9 months (OR 18.96, 95% CI 6.63–54.19), 12 months (OR 40.25, 95% CI 14.14–114.58), 18 months (OR 90.02, 95% CI 30.84–262.77) and 24 months (OR 82.14, 95% CI 27.23–247.83). Conclusion Our study revealed that Infant and young child feeding practices are significantly associated with maternal education, employment, and the child’s age. Therefore, it is essential that investments be made towards protective breastfeeding and complementary feeding policies and legislations, emphasis on female education and ensuring the availability of affordable nutritious and diverse foods.

Priority Micronutrient Density of Foods for Complementary Feeding of Young Children (6–23 Months) in South and Southeast Asia

“…Unavailability and unaffordability, as well as insufficient maternal education, were identified as some of the main factors limiting consumption of animal-source foods and nutrient-dense foods in general among infants and young children in the two regions (2,10,41,42). Indeed, while some foods of animal origin, such as liver, eggs and dairy, may be more available and affordable than others (particularly in terms of cost per nutrients provided), efforts to increase access to and knowledge around ASFs in South and Southeast Asia are still needed (43).…”

Breastfeeding Practices, Infant Formula Use, Complementary Feeding and Childhood Malnutrition: An Updated Overview of the Eastern Mediterranean Landscape

“…In addition, a Lebanese study conducted in 2017 showed that the proportion of exclusively breastfed infants declined from 40% at age 2 months to 2% at 4–6 months [ 62 ]. Many other EMR countries showed similar trend such as Jordan (at birth: 51%, at 1 month: 47%, at 6 months: 33%) [ 56 ], Iran (at discharge:74.3%, at 6 months: 28%) [ 46 ], Pakistan (at 3 months: 74.4%, at 6 months: 30.2%) [ 72 ], Qatar (at 1–3 months: 40%, at 4–6 months: 20%) [ 19 ], Saudi Arabia (at birth: 88.6%, at 1 month: 49%, at 2 months: 36.1%, at 4 months: 20.5%, at 6 months: 10.2%) [ 80 ] and United Arab Emirates (at 0–3.9 months: 45%, at 0–6 months: 37%, at 4–5.9 month: 26%) [ 16 ]. Additionally, over time, some countries in the region have seen a decline in the prevalence of exclusive breastfeeding.…”

“…The lowest rates were seen for Kuwait (12%) [ 60 ], Saudi Arabia (11.1%) [ 80 ] and United Arab Emirates (1%) [ 16 ]. However, the highest rates were reported from Afghanistan (73.8%) [ 37 ], Iran (70.5%) [ 47 , 50 ], Sudan (68.2%) [ 37 , 85 , 86 , 87 ], Pakistan (65.1%) [ 23 , 37 , 72 , 73 , 74 ] and Oman (64.1%) [ 29 , 70 , 71 ]. The prevalence of continued breastfeeding decreased the most at 2 years of age.…”

Impact of Using Social Marketing Principles on Promoting Breastfeeding Practices and Physical Growth: an Egyptian Community Based Longitudinal Study

“…The rst 2 years of life are crucial as during this period, the body lays the foundation for the future growth and development of a child. Any nutritional de ciencies during this time can be manifested in the form of impaired cognitive development, and physical growth (29,30) compromised educational achievement, and ultimately low economic productivity later in life (31). Furthermore, the role of breastfeeding in boosting child immunity was evident and the weaknesses of eating habits decreased child immunity and considered as an entry point to COVID-19 (32) and as a trigger for increasing phobia (33) Optimization of breastfeeding practices could reduce high mortality rates in children younger than 5 years.…”