Complementary Feeding Practices in 80 Low- and Middle-Income Countries: Prevalence of and Socioeconomic Inequalities in Dietary Diversity, Meal Frequency, and Dietary Adequacy

Abstract

Background Adequate complementary feeding practices in early childhood contribute to better food preferences and health outcomes throughout the life course. Objectives The aim of this study was to describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6–23 mo in 80 low- and middle-income countries. Methods We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6–23 mo included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles), gross domestic product (GDP) per capita, and absolute (estimated household income) socioeconomic indicators. Statistical analyses included calculation of the slope index of inequality, Pearson correlation and linear regression, and scatter diagrams. Results Only 21.3%, 56.2%, and 10.1% of the 80 countries showed prevalence levels >50% for MDD, MMF, and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF it was East Asia & the Pacific. Log GDP per capita was positively associated with MDD (R2 = 48.5%), MMF (28.2%), and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the 3 indicators; pro-poor inequalities were observed in 2 countries for MMF, and in none for the other 2 indicators. Breast milk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods, and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded ∼US$20,000. All 3 dietary indicators improved by age and no consistent differences were observed between boys and girls. Conclusions Monitoring complementary feeding indicators across the world and implementing policies and programs to reduce wealth-related inequalities are essential to achieve optimal child nutrition.

Wealth- and education-related inequalities in minimum dietary diversity among Indonesian infants and young children: a decomposition analysis

“…Our result of pro-rich wealth-related inequalities in MDD was in line with previous studies [ 28 , 32 ]. Although no study has assessed education-related inequality in MDD, the distribution of infant and young child feeding indicators was higher among mothers with higher education in several studies [ 40 , 41 ].…”

“…Dietary diversity increases with economic improvements [ 12 , 28 ]; however, Indonesia may not be the case. Over the last 22 years, Indonesia experienced a substantial economic change.…”

“…Socioeconomic inequalities pose a significant challenge to optimal feeding practices [ 28 ]. However, very few studies have examined the extent of socioeconomic disparities related to dietary diversity and the factors contributing to the inequality [ 31 , 32 ].…”

Dietary Diversity and Undernutrition in Children Aged 6–23 Months in Sub-Saharan Africa

“…Nutrition is an essential component of the Sustainable Development Goal (SDG) 2 which focuses on zero hunger by 2030 [1]. However, many parents, particularly those in low-and middle-income countries struggle to provide dietary diversity for children [2]. Dietary diversity is considered to be an outcome of the nutritional status of children [3,4] and a key component of high-quality diets [5][6][7].…”

Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda

“…Marginalisation is linked to poverty [53][54][55]; the Indigenous Batwa communities are among the poorest communities in the world [18]. Studies have shown how wealth index and education level influences nutritional status [56,57]; indeed, both Batwa and Bakiga populations have extremely low education levels and income, and suffer from undernutrition and stunting, especially in children under 5 years [20].…”