Association of Infant Feeding Indicators and Infant Feeding Practices with Coexisting Forms of Malnutrition in Children under Six Months of Age

Abstract

Breastmilk is the only recommended source of nutrition for infants below six months of age. However, a significant proportion of children are either on supplemental breastfeeding (SBF) or weaned due to the early introduction of solid/semi-solid/soft food and liquids (SSF) before six months of age. There is good evidence that exclusive breastfeeding (EBF) in infants below six months of age protects them from preventable illnesses, including malnutrition. The relationship between infant feeding practices and coexisting forms of malnutrition (CFMs) has not yet been explored. This study examined the association of different feeding indicators (continuation of breastfeeding, predominant feeding, and SSF) and feeding practices (EBF, SBF, and complete weaning) with CFM in infants aged below six months in Pakistan. National and regional datasets for Pakistan from the last ten years were retrieved from the Demographic Health Surveys (DHS) and UNICEF data repositories. In Pakistan, 34.5% of infants have some form of malnutrition. Among malnourished infants, 44.7% (~15.4% of the total sample) had a CFM. Continuation of breastfeeding was observed in more than 85% of infants, but less than a quarter were on EBF, and the rest were either SBF (65.4%) or weaned infants (13.7%). Compared to EBF, complete weaning increased the odds of coexistence of underweight with wasting, and underweight with both wasting and stunting by 1.96 (1.12–3.47) and 2.25 (1.16–4.36), respectively. Overall, breastfed children had lower odds of various forms of CFM (compared to non-breastfed), except for the coexistence of stunting with overweight/obesity. Continuation of any breastfeeding protected infants in Pakistan from various types of CFM during the first six months of life.

Determinants of coexisting forms of undernutrition among under‐five children: Evidence from the Bangladesh demographic and health surveys

“…Preceding studies evolved that a child of families with no education is more likely to have malnutrition (Ahmed et al, 2021; Babatunde & Qaim, 2010; Olwedo et al, 2008). A previous study exhibits a similar relationship between the coexistence of underweight with wasting and stunting and the education of mothers (Khaliq, Wraith, Miller, & Nambiar, 2022). This study has shown that the marital age of the mother is significantly associated with child malnutrition which is also corroborated by a survey conducted in rural areas of Nepal (Wells et al, 2022).…”

“…Other remaining studies focused to identify factors linked to the double burden of malnutrition. Earlier research also explored the prevalence, patterns, and factors that cause the coexisting forms of malnutrition in neonates, infants, and children (Khaliq et al, 2021 ; Khaliq, Wraith, Miller, & Nambiar, 2022 ; Khaliq, Wraith, Nambiar, & Miller, 2022 ). In the context of Bangladesh, there is a lack of evidence focusing on the determinants of the presence of CFM considering the most recent countrywide survey BDHS‐2017/18 data.…”

Assessment of Determinants of Paediatric Diarrhoea Case Management Adherence in Pakistan

“…We can postulate that exclusive breastfeeding (EBF) recommendation for children aged below six months can be one of the preponderant reasons for the low adherence among young children. During the EBF period, it is advisable to use ORS, medicine, multivitamins, and vaccines in conjunction with breast milk [ 32 , 33 ]. However, any solid, semi-solid, liquid, and soft food during the first six months of life reflect a deviation from the recommended feeding standards [ 32 ].…”

“…During the EBF period, it is advisable to use ORS, medicine, multivitamins, and vaccines in conjunction with breast milk [ 32 , 33 ]. However, any solid, semi-solid, liquid, and soft food during the first six months of life reflect a deviation from the recommended feeding standards [ 32 ].…”

Dietary Diversity, Stunting, and the Impact of an Education Program on Parents’ Knowledge and Attitudes in West Sumba, Indonesia

“…Most reports suggest that a mother's education is recognized as a fixed parameter regardless of whether many mothers (who are economically and educationally limited) attend school after their children's births (De Silva & Sumarto 2018). For instance, in Indonesia, it was reported in some studies that higher levels of maternal education reduced malnutrition levels (maternal and child double burden) in rural areas (Khaliq et al 2022) and some cities in Indonesia (Mahmudiono et al 2016;Mitra et al 2020). Those studies highlight the importance of nutrition education among parents or caregivers to improve their awareness and knowledge, and in the long run, their attitudes and behaviours.…”