Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey

Abstract

Background Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices. Methods We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. Results The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children’s books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices. Conclusions Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal.

“Little children learn on their own by observing and imitating.” Caregivers’ perspectives on cognitive and socio-emotional caregiving practices for children 0-3 years in lowland Nepal

“…As our data are from 2012, some changes in caregiving practices may have occurred. However, the gap in caregiving practices found here appears to have remained since a recent study conducted in Dhanusha district found similar ndings [25,29].…”

“…We conducted a qualitative study in July 2012 to further explain ndings from quantitative research undertaken with the same study population [25] and generate a holistic understanding of cognitive and socio-emotional caregiving for children under three years in Dhanusha district, Nepal. The study was conducted by the local Non-governmental Organisation (NGO) Mother and Infant Research Activities (MIRA), Nepal, in collaboration with the Institute for Global Health, University College London, United Kingdom.…”

“…A cross-sectional survey in lowland Nepal highlighted suboptimal cognitive and socio-emotional caregiving practices among children aged 7-59 months [25]. Indicators of caregiving with the largest de cits were i) access to three or more children's books (7%), ii) early stimulation and responsive caregiving (11%), and iii) participation in early childhood education (27%).…”

Colostrum Feeding among Newborns Visiting the Outpatient Department of Pediatrics of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“… 4 , 11 In a similar study done in an urban population of Western Nepal, Midwestern Nepal and Eastern Nepal it was 72.7% and 67.2% respectively, which is more as compared to our study. 8 , 12 …”

Feeding practices, dietary adequacy, and dietary diversities among caregivers with under-five children: A descriptive cross-section study in Dodoma region, Tanzania

“…Tanzania is inclusive with the problem of nutrition for under-five year children of which Tanzania Demographic and Health Survey data shows that 59% of infants are exclusively breastfed for six months, 39% of 6–24 months children are given minimum recommended meal frequency and 26 percent are given minimum recommended diverse diet [ 16 ]. Despite the huge progress achieved in the country yet, the majority of children are not fed at the Minimum Dietary Diversity (MDD) [ 17 ]. The most common food types caregivers feed children include 91% grains, roots, and tubers and 65% Vitamin A containing fruits and vegetables [ 18 ].…”