Trends and predictors of appropriate complementary feeding practices in Nepal: An analysis of national household survey data collected between 2001 and 2014

Abstract

There is evidence that suboptimal complementary feeding contributes to poor child growth. However, little is known about time trends and determinants of complementary feeding in Nepal, where the prevalence of child undernutrition remains unacceptably high. The objective of the study was to examine the trends and predictors of suboptimal complementary feeding in Nepali children aged 6-23 months using nationally representative data collected from 2001 to 2014. Data from the 2001, 2006, and 2011 Nepal Demographic and Health Surveys and the 2014 Multiple Indicator Cluster Survey were used to estimate the prevalence, trends and predictors of four WHO-UNICEF complementary feeding indicators: timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). We used multilevel logistic regression models to identify independent factors associated with these indicators at the individual, household and community levels. In 2014, the weighted proportion of children meeting INTRO, MMF, MDD, and MAD criteria were 72%, 82%, 36% and 35%, respectively, with modest average annual rate of increase ranging from 1% to 2%. Increasing child age, maternal education, antenatal visits, and community-level access to health care services independently predicted increasing odds of achieving MMF, MDD, and MAD. Practices also varied by ecological zone and sociocultural group. Complementary feeding practices in Nepal have improved slowly in the past 15 years. Inequities in the risk of inappropriate complementary feeding are evident, calling for programme design and implementation to address poor feeding and malnutrition among the most vulnerable Nepali children.

Predictors of complementary feeding practices in Afghanistan: Analysis of the 2015 Demographic and Health Survey

“…Second, knowledge, attitudes, and practices need to be aligned with children's nutritional needs, where household poverty is not a constraint to appropriate complementary feeding practices. Both timing of complementary food introduction and meal frequency practices are likely less constrained by household wealth, as repeatedly seen in the literature (Joshi, Agho, Dibley, Senarath, & Tiwari, ; Kabir et al, ; Na, Aguayo, Arimond, Dahal, et al, ; Na, Aguayo, Arimond, Narayan, et al, ; Na, Aguayo, Arimond, & Stewart, ; Senarath, Godakandage, Jayawickrama, Siriwardena, & Dibley, ) and are less likely to be associated with general socioeconomic progress over time (Na, Aguayo, Arimond, Dahal, et al, ; Na, Aguayo, Arimond, Narayan, et al, ). Our analysis indicates that timely introduction of complementary foods was not constrained by household wealth.…”

“…Child MDD and MAD were both extremely poor as less than one‐fifth of children aged 6–23 months achieved these criteria. Current complementary feeding practices in Afghanistan are among the poorest in South Asia, a region where only 15–32% of children meet the MAD criteria (International Institute for Population Sciences, M. I, ; Na, Aguayo, Arimond, Dahal, et al, ; Na, Aguayo, Arimond, & Stewart, ; National Institute of Population Research and Training, Mitra and Associates,, & ICF International, ).…”

Stagnating trends in complementary feeding practices in Bangladesh: An analysis of national surveys from 2004‐2014

“…The declining trend in MMF in Bangladesh was in contrast to the slow progress observed in Nepal over the same period of time from 68% in 2001 to 82% in 2014 (Na et al, ). More importantly, our analysis indicates that some vulnerable subpopulations, including children of mothers with no formal education and children from the poorest wealth quintile households, experienced a greater deterioration in MMF.…”

“…Fourth, feasible and simple indicators are needed for targeting programmes and resources towards communities where CF practices are poor. Though the community‐level access to health care indicator independently differentiated the odds of meeting only one CF indicator in Bangladesh, a similarly derived community‐level indicator strongly predicted the odds of meeting MDD and MAD criteria in Pakistan and Nepal (Na, Aguayo, Arimond, Dahal, et al, ; Na, Aguayo, Arimond, & Stewart, ). From an implementation perspective, community‐level interventions by trained community volunteers and health care workers have potential to reach vulnerable populations at scale.…”

Aiming higher for maternal and child nutrition in South Asia

“…Together with a previously published study in Pakistan (Na, Aguayo, Arimond, & Stewart, ), the analyses show that complementary feeding practices are more likely to be suboptimal among infants (6–11 months), children who are first born, children whose mothers are younger or less educated, and in communities with poor access to health and nutrition services in these countries. Na, Aguayo, Arimond, Dahal, et al, () find that Nepalese children with perceived LBW are also fed less diverse diets, which may stem from beliefs that they are too weak to digest some types of food; similar findings have been reported in Pakistan (Na et al, ). In addition, Na, Aguayo, Arimond, Dahal, et al, () report that cultural beliefs continue to be a barrier to recommended feeding practices in Nepal, where the Dalit and minority ethnic and religious castes have poorer complementary feeding practices than other population groups.…”