The Haitian National Nutrition Policy identifies the promotion of optimal complementary feeding (CF) practices as a priority action to prevent childhood malnutrition. We analysed data from the nationally representative 2005-2006 Haiti Demographic Health Survey using the World Health Organization 2008 infant and young child feeding indicators to describe feeding practices among children aged 6-23 months and thus inform policy and programme planning. Multivariate regression analyses were used to identify the determinants of CF practices and to examine their association with child growth outcomes. Overall, 87.3% of 6-8-month-olds received soft, solid or semi-solid foods in the previous 24 h. Minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) were achieved in 29.2%, 45.3% and 17.1% of children aged 6-23 months, respectively. Non-breastfed children were more likely to achieve MDD than breastfed children of the same age (37.3% vs. 25.8%; P < 0.001). The proportion of children achieving MMF varied significantly by age (P < 0.001). Children with overweight mothers were more likely to achieve MDD, MMF and MAD [odds ratio (OR) 2.08, P = 0.012; OR 1.81, P = 0.02; and OR 2.4, P = 0.01, respectively] than children of normal weight mothers. Odds of achieving MDD and MMF increased with household wealth. Among mothers with secondary or more education, achieving MDD or MAD was significantly associated with lower mean weight-for-age z-score and height-for-age z-score (P-value <0.05 for infants and young child feeding indicator × maternal education interaction). CF practices were mostly inadequate and contributed to growth faltering among Haitian children 6-23 months old.

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Haiti's national nutrition policy prioritises breastfeeding, but limited data are available to inform strategy. We examined national trends in early initiation of breastfeeding (ErIBF) and exclusive breastfeeding (EBF) over a 10-year period using data from three Haitian Demographic and Health Surveys (1994-1995, 2000 and 2005-2006). We used multivariate regression methods to identify determinants of ErIBF and EBF in the 2005-2006 data set and to examine relationships to growth. There was no change in ErIBF across surveys [1994-1995: 36.6%, 95% confidence interval (CI) 29.9-43.9; 2000: 49.4%, 95% CI 44.1-54.8; 2005-2006: 43.8%, 95% CI 40.5-47.1]. EBF among 0-5-month-olds increased sharply (1994-18995: 1.1%, 95% CI 0.4-3.2; 2000: 22.4%, 95% CI 16.5-29.5; 2005-2006: 41.2%, 95% CI 35.4-47.2). The proportion of breastfeeding children 0-5 months who received soft, solid or semi-solid foods decreased (1994-1995: 68.5%, 95% CI 57.3-77.9; 2000: 46.3%, 95% CI 39.3-53.4; 2005-2006: 30.9%, 95% CI 25.9-36.5). Child age at time of survey [odds ratio (OR) 1.73; P = 0.027], lower maternal education (OR = 2.14, P = 0.004) and residence in the Artibonite Department (OR 0.31; P = 0.001) were associated with ErIBF among children 0-23 months. Age group and department were significant predictors of EBF among children 0-5 months. ErIBF was associated with higher weight-for-age z-scores [effect size (ES) 0.22; P = 0.033] and height-for-age z-scores (ES 0.20; P = 0.044). There was no statistically significant relationship between EBF and growth. The 10-year ErIBF and EBF trends in Haiti echo global and regional trends. ErIBF and EBF are related practices but with different determinants in the Haitian context. These differences have implications for intervention delivery.

A variety of nutrition interventions are needed to meet national and global goals for women and children, and scarce resources necessitate integration of those activities. Haiti's national nutrition strategy includes 3 priority intervention areas: 1) promotion of age‐appropriate infant and young child feeding (IYCF) practices 2) prevention of micronutrient deficiencies (PMD) in young children, adolescent girls and pregnant women and 3) management of severe acute malnutrition (SAM) in children under 5. Policy makers need to identify program delivery models that effectively integrate these areas at the community level. To address the question of integration, we mapped the program impact pathways for 3 large‐scale nutrition programs serving rural Haitian communities. Two programs were managed by NGOs and one by the public sector. For each program, we assessed how activities related to IYCF, PMD, and SAM were integrated at the service delivery level. Data was collected through document review and semi‐structured interviews with program staff and beneficiaries. Analyses and findings reveal ways that various community‐based nutrition activities can be most efficient and synergistic. Research support: UNICEF Haiti

Objectives The objective was to assess serum retinol concentration in women of reproductive age from Haiti by HPLC and a portable photometer, as well as the presence of anemia and hemoglobin (Hb) concentration. Methods Cross-sectional comparative study design. Women of reproductive age from the program to improve food security in Haiti (AKOSAA) were eligible to participate. Weight and height were measured and Body Mass Index (BMI) was calculated. A sample of venous blood (5 mL) was collected to assess serum retinol (SR) using HPLC and a portable photometer. Hemoglobin concentration was determined using HemoCue and C-reactive protein (Spinreact E-17176, St Esteve de Bas), was used as a marker of inflammation. Results Age range among participants (n = 163) was 15–50 years old. Low weight was identified in15% (n = 24) of enrolled women according to BMI. Vitamin A deficiency (VAD) was identified in 55% (n = 90) of the study population according to serum retinol assessed by HPLC (reference method) versus 26.4% identified using the portable photometer (weighted Kappa = 0.10), which is considered extremely poor. Severe VAD was not found but mild and severe VAD was identified in 38.7% and 16% of women, respectively. When the difference and average of measurements of both methods were compared, bias was 0.20 (IC 95%: 0.14, 0.27). Lin's concordance coefficient (ρc), an analysis of accuracy and precision that assesses how every pair of observations falls over the line of identity (45°), was extremely poor, because it was found below 0.90 (ρc = 0.19). On the other hand, 45% (n = 73) of participants had anemia (Hb < 12 g/dL). No inflammation was observed, since C-reactive protein was below 6 mg/L. Conclusions In Haiti VAD as well as anemia were found to be a public health problem. As long as the socioeconomical situation does not substantially improve in this región, supplementation policies and food fortification must be implemented to be able to fight hidden hunger. Funding Sources International Atomic Energy Agency (IAEA) CRP contract No. 18,223. Sight and Life donated the iCheckFluoro® equipment and reagents.