Feeding Patterns, Mother-Child Dietary Diversity and Prevalence of Malnutrition Among Under-Five Children in Lebanon: A Cross-Sectional Study Based on Retrospective Recall

Abstract

BackgroundDespite demonstrated benefits, most countries fall short of meeting international targets for breastfeeding patterns, optimal complementary feeding, mother-children's quality diet, and malnutrition among under-five children.RationaleSince mothers usually play the most vital role in the healthcare of their children, research is needed to illuminate maternal factors that might promote a child's health and nutritional status.AimThe purpose of this study is to retrospectively (1) examine the under-five children's (0–59 months) feeding habits including exclusive breastfeeding, exclusive bottle feeding, continued breastfeeding, and complementary feedings, (2) investigate the mother-child's dietary diversity, and (3) identify any factors that cause less optimal nutrition due to a lack of food diversity in children aged 6 to 59 months. Moreover, (4) the prevalence of wasting, stunting, underweight, and overweight in the under-five offspring living in households located in the main two provinces in Lebanon (Beirut and Mount Lebanon) was determined.MethodsThe data for this analysis were collected from a representative sample of 384 households [384 mothers (21–49 years old) and children (0–59 months)] between February 2019 and June 2019. A questionnaire was used to inquire mothers of children ages 0–23 months about exclusive breastfeeding (EBF), continuous breastfeeding (CBF), exclusive bottle feeding (EBOT), mixed feeding (MF), and complementary feeding patterns. Moreover, additional questions regarding dietary diversity were asked to mothers of children aged 6 to 59 months. This score was calculated based on the 24 h recall of the mother and her child's consumption of 7 food groups, during the 24 h prior to the survey. Moreover, stunting, wasting, overweight, and underweight were calculated using the z-score for height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ), respectively. Binary logistic regression was used to explore the dietary diversity among children (ages 6–59 months) adjusting for covariates at maternal and household levels.ResultsAround 44% of children (0–59 months) had normal body weight. In addition, 9.3% were underweight (WAZ < -2SD to −3SD), 6.5% were at risk of being overweight, 24.45% were overweight, 9.3% were stunted (HAZ < -2SD to −3SD), and 6.25% (WHZ < -2SD to −3SD) were wasted. In total, among under-five children, the prevalence of EBF at 40 d and 6 months was 27 and 30%, respectively. The prevalence of CBF was 23%. Around 60% of mothers breastfed their offspring between 0 and 6 months and half of them introduced infant formula at earlier stages between 0–6 months. Furthermore, 78.4% of mothers introduced food to their children between 4 and 6 months (of which 40% before 6 months) and 62.5% of them introduced sugary drinks before 6 months. As for dietary diversity (DD), one out of two mothers and one out of three children (ages 6–59 months) had a low DD score (DDS) (46 and 32%, respectively). The children's and mother's DD were strongly found to be correlated (p-value = 0.034). Regression analysis showed that children's DD increased around 2 times [AOR = 1.7; 95% CI (1.042–2.914)] in context of high maternal DDS, and about 12 times [AOR = 11.7; 95% CI (1.2–111)] when a member of the highest-income households.ConclusionsOur findings demonstrated low rates of EBF and CBF, high prevalence of EBOT, and early introduction of complementary foods among children ages 0–59 months. Furthermore, for children ages 6–59 months, there was poor mother-child dietary diversity and a high prevalence of overweight and stunted children in the main two Lebanese provinces. This suggests the alarming need for continuous nutrition intervention to improve infant feeding patterns and dietary diversity to reduce the malnutrition rates.

Correlates of Sub-Optimal Feeding Practices among under-5 Children amid Escalating Crises in Lebanon: A National Representative Cross-Sectional Study

“…However, it remains far below the WHO recommendation of 70% [ 4 ]. On the other hand, among our study population, the prevalence of bottle feeding between 0 and 6 months was 59.5%; this rate was lower than the one reported in 2019 before the current escalating crises [ 26 ]. Moreover, the prevalence of mixed milk feeding since birth in our study was 29%, which is higher than the prevalence in the period preceding the devastating crises [ 26 ] but lower that that stated in the recent national SMART survey [ 25 ].…”

“…On the other hand, among our study population, the prevalence of bottle feeding between 0 and 6 months was 59.5%; this rate was lower than the one reported in 2019 before the current escalating crises [ 26 ]. Moreover, the prevalence of mixed milk feeding since birth in our study was 29%, which is higher than the prevalence in the period preceding the devastating crises [ 26 ] but lower that that stated in the recent national SMART survey [ 25 ]. The increase in exclusive breastfeeding rates along with the decrease in bottle feeding could be due to the shortages of infant milk formula that are one facet of a food security challenge brought on by economic collapse and worsened by Lebanon’s reliance on imports for basic necessities such as fuel and wheat [ 33 ].…”

“…Regarding complementary feeding practices in the current study, only 47.1% of mothers adhered to the WHO recommendations to introduce foods at 6 months. It is noteworthy that the prevalence of introducing solid foods at less than 6 months of age was lower than that reported in 2019 [ 26 ]. Currently, we found that 51.8% of the mothers introduced food between 4 and 6 months, from which 14.8% started introducing solid foods at the age of 4 months.…”

“…Similarly, our findings came hand in hand with the results of a recent cross-sectional Lebanese study that found that among under-5 children, the prevalence of exclusive breastfeeding at 40 days and at 6 months was 27% and 30%, respectively, and the prevalence of continued breastfeeding was 23%. The same study stated as well that around 60% of mothers breastfed their offspring between 0 and 6 month and half of them introduced infant formula at earlier stages between 0 and 6 months [ 26 ]. In comparison with other national studies, our findings show that there has been a higher prevalence of exclusive breastfeeding since 2015.…”

“…Currently, we found that 51.8% of the mothers introduced food between 4 and 6 months, from which 14.8% started introducing solid foods at the age of 4 months. However, in 2019, 60% of the mothers introduced complementary foods between 4 and 6 months, from which 40% started introducing solid foods before the age of 6 months [ 26 ]. In comparison with the findings reported by the national SMART survey (78.5%) [ 25 ], and that reported by UNICEF for the EMR (68%) [ 32 ], Jordan (83%) [ 35 ], and UNICEF at global level (73%) [ 32 ], the prevalence of introducing food at 6 months in our study was low (47.1%).…”