Evaluation of MAHD (Minimum Acceptable Hygienic Diet) As a New Composite IYCF Feeding Indicator to Assess the Appropriateness of Complementary Feeding

Abstract

Background-Development of feeding indicators to assess the appropriateness of complementary feeding practices of mothers has been a major area of research in prevention of child morbidity and mortality. The most important determinant of appropriateness of complementary feeding are nature and composition of food gradients which should adequately provide recommended nutrients. Assessment of adequacy of different nutrients in complementary food of greatly varying nature and composition is very difficult and complex in day-to-day routine practices. WHO has developed MMF, MDD and MAD as feeding indicators which asses only nutritional adequacy of complementary feed but do not asses their hygienic quality while food borne enteric diseases pose a global challenge to optimum growth of children below 2 years of age. The present study designed and constructed a new feeding indicator MAHD (Minimum Acceptable Hygienic Diet) addressing hygienic quality of the complementary feed to quantitate the appropriateness of complementary feeding more accurately. Methodology-A cross-sectional study was made on quantitative and qualitative data collected from 300 mother child pairs using semi-structured questionnaire pre-designed in light of WHO IYCF indicators as well as our newly structured indicators along with clinical and anthropometric examination of babies for assessing their nutritional and health status. The data were used for evaluating association of feeding indicators with nutritional status of the babies. Result-The WHO IYCF feeding indicators better explained and associated with the growth indicators like WAZ, HAZ, WHZ in this study contrary to unequivocal and mixed result in previous studies. It was so because attempt was made to ascertain daily routine practice on MMF, MDD and MAD in place of 24 hours memory recall of child feeding as done in previous studies. Newly designed and constructed feeding indicator MAHD (Minimum Acceptable Hygienic Diet) was proven to be more appropriate feeding indicator to evaluate appropriateness of complementary feed. It was so because association of MAHD feeding indicator with growth indicators were found to be very close to normal median range of WHO Z-growth scores. Although MAHD was found to be practiced only by 37% of mothers, this feeding indicator was found to be associated more with optimum growth indicators. Conclusion-It was opined that along with fulfilling dietary diversity and minimum meal frequency, maintenance of food and feeding hygiene is very essential in prevention of under nutrition and thereby morbidity and mortality in children below 2 years of age. In this respect, storing of food at room temperature for not more than 2 hours was found to be important barrier in hygienic complementary feeding practices. It was so, because washing of hands and utensils were being practiced by majority of the mothers. It warrants to raise awareness among mothers about safe and hygienic storing of food. MAHD can also be useful in on-spot diagnosis of malnutrition on the basis of dietary history of complementary feeding.