In Cambodia, the energy and nutrient densities of the traditional rice-based complementary diets used for infant feeding are very low. Whether the adequacy improves after the first year of life is uncertain. Therefore, we examined the feeding practices and the energy and nutrient intakes from non-breastmilk foods (NBMFs) of two groups: partially breastfed (PBF) (n = 41) and non-breastfed (NBF) (n = 210) stunted toddlers aged 12-42 months from poor villages in Phnom Penh, Cambodia. Intakes of NBMFs were estimated from 24-h recalls and a specially constructed Cambodian food composition table. All the toddlers were breastfed initially, but more than 50% received complementary foods before 6 months of age (mainly rice porridge). Many PBF toddlers received mixed feeding and were often bottle-fed diluted sweetened condensed milk. Unresponsive feeding was widespread. Inappropriate snacks, such as crisps, were the major source of energy, calcium, iron, zinc and vitamin A from NBMFs for the PBF group, and energy and iron for the NBF group. The snacks were often purchased and consumed without any adult supervision. For both groups, intakes of energy, calcium, iron and zinc were consistently below recommendations, as a result of the low micronutrient density of NBMFs and the small amounts fed per feeding. Increasing intakes of animal-source foods and dark-green and yellow fruits and vegetables would enhance micronutrient densities, although this may be neither feasible nor sufficient to overcome the existing deficits. Instead, the feasibility of micronutrient fortification of the rice-based diets of Cambodian toddlers should be explored.

Abstract

The Cambodian diet is low in nutrient-dense animal-source foods. Enhanced homestead food production (EHFP) and aquaculture, which increase availability of nutrient-dense foods, are promising interventions to improve dietary intake. This study examined the effect of EHFP with or without aquaculture on dietary intake and prevalence of inadequate intake of select nutrients among women and children living in rural Cambodia, compared to controls. In a registered, cluster randomized controlled trial in Prey Veng, Cambodia, 10 households in each of 90 villages (n = 900) were randomized by village to receive EHFP, EHFP plus aquaculture, or control. After 22-month intervention, 24-hr dietary recalls (24HRs) were collected from mothers aged 18-50 years (n = 429) and their children aged 6 months-7 years (n = 421), reported by their mothers. Usual intake distributions (generated using 24HRs and repeat 24HRs on a subsample) were used to estimate prevalence of inadequate intake. Compared to controls, women in the EHFP group had significantly higher zinc (+1.0 mg/d) and Vitamin A (+139 retinol activity equivalents/d) intakes, and women in the EHFP plus aquaculture group had significantly higher iron (+2.7 mg/d), Vitamin A (+191 retinol activity equivalents/d), and riboflavin (+0.17 mg/d) intakes. Women in the EHFP plus aquaculture group also had significantly lower prevalence of inadequate iron (-7%, at 10% bioavailability), Vitamin A (-19%), and riboflavin (-17%) intakes, compared to controls. No significant differences in intakes or nutrient adequacy were observed among children or between EHFP and EHFP plus aquaculture groups. The biological importance of the small differences in nutrient intakes among women remains to be established.

in Bangladesh, which has been used to conduct regular surveillance and special surveys to provide information on health and nutritional status of children and mothers, and report on the coverage and impact of nutrition and health programs in Bangladesh. The Government of Bangladesh (GOB) distributes vitamin A Capsule (VAC) among children aged 12-59 months biannually. The NSP data was analyzed to assess VAC coverage and to explore which children were less likely to receive a VAC in order to help GOB identify necessary modifications aimed at higher coverage of VAC among all eligible children. Results showed that coverage among girls and boys was not different (P=0.970). However, coverage was consistently lower among children aged 12-23 months compared to older children (24-59 months) (P≤0.001) in each of the distribution rounds. Coverage among children from poorer households was lower than among children from wealthiest households (P<0.001), with the extent of this difference varying by round. Coverage was significantly higher if households had had contact with a government health assistant in the last month (P<0.001); and among households who owned a radio or a TV compared to those who did not. The VAC distribution campaign needs to be strengthened to cover the children who are currently not reached; especially younger children, children living in underserved regions, children from poorer households and from households with less contact with health service providers or mass media.