Penelope Burns

Determinants of inadequate complementary feeding practices among children aged 6-23 months in Ghana.

OBJECTIVE To explore complementary feeding practices and identify potential risk factors associated with inadequate complementary feeding practices in Ghana by using the newly developed WHO infant feeding indicators and data from the nationally representative 2008 Ghana Demographic and Health Survey. DESIGN The source of data for the analysis was the 2008 Ghana Demographic and Health Survey. Analysis of the factors associated with inadequate complementary feeding, using individual-, household- and community-level determinants, was done by performing multiple logistic regression modelling. SETTING Ghana. SUBJECTS Children (n 822) aged 6-23 months. RESULTS The prevalence of the introduction of solid, semi-solid or soft foods among infants aged 6-8 months was 72.6 % (95 % CI 64.6 %, 79.3 %). The proportion of children aged 6-23 months who met the minimum meal frequency and dietary diversity for breast-fed and non-breast-fed children was 46.0 % (95 % CI 42.3 %, 49.9 %) and 51.4 % (95 % CI 47.4 %, 55.3 %) respectively and the prevalence of minimum acceptable diet for breast-fed children was 29.9 % (95 % CI 26.1 %, 34.1 %). Multivariate analysis revealed that children from the other administrative regions were less likely to meet minimum dietary diversity, meal frequency and acceptable diet than those from the Volta region. Household poverty, children whose mothers perceived their size to be smaller than average and children who were delivered at home were significantly less likely to meet the minimum dietary diversity requirement; and children whose mothers did not have any postnatal check-ups were significantly less likely to meet the requirement for minimum acceptable diet. Complementary feeding was significantly lower in infants from illiterate mothers (adjusted OR=3.55; 95 % CI 1.05, 12.02). CONCLUSIONS The prevalence of complementary feeding among children in Ghana is still below the WHO-recommended standard of 90 % coverage. Non-attendance of postnatal check-up by mothers, cultural beliefs and habits, household poverty, home delivery of babies and non-Christian mothers were the most important risk factors for inadequate complementary feeding practices. Therefore, nutrition educational interventions to improve complementary feeding practices should target these factors in order to achieve the fourth Millennium Development Goal.

Determinants of suboptimal complementary feeding practices among children aged 6-23 months in four anglophone West African countries

Suboptimal complementary feeding practices have a detrimental impact on a childs growth, health and development in the first two years of life. They lead to child malnutrition, which contributes to the high prevalence of stunting (38%) and underweight (28%) reported for children <5 years of age in Sub-Saharan Africa. This study analysed complementary feeding practices in four anglophone West African countries (Ghana, Liberia, Nigeria and Sierra Leone) using the most recent Demographic and Health Surveys. The study covered 12 623 children aged 6-23 months from four anglophone West African countries (Ghana: 822 children: Liberia: 1458 children, Nigeria: 8786 children and Sierra Leone: 1557 children). Four complementary feeding indicators were examined against a set of individual-, household- and community-level factors, using multiple regression analysis. Multivariate analyses found that lack of post-natal contacts with health workers, maternal illiteracy and geographical region were common determinants of delayed introduction of solid, semi-solid or soft foods across all four countries. Predictors for minimum dietary diversity, minimum meal frequency and minimum acceptable diet included children aged 6-11 months, administrative/geographical region, poorer household income and limited access to media. The authors recommend that the four anglophone West African countries studied should prioritise efforts to improve complementary feeding practices in order to reduce child morbidity and mortality. Interventional studies on complementary feeding should target those from poor and illiterate households.

Determinants of Early Introduction of Solid, Semi-Solid or Soft Foods among Infants Aged 3–5 Months in Four Anglophone West African Countries

This study was conducted to explore and identify factors associated with the practice of early introduction of solid, semi-solid or soft foods among infants aged 3–5 months in four Anglophone West African countries. Data sources for the analyses were the latest Demographic and Health Survey datasets of the 4 countries, namely Ghana (GDHS, 2008), Liberia (LDHS, 2007), Nigeria (NDHS, 2013) and Sierra Leone (SLDHS, 2008). Multiple logistic regression methods were used to analyze the factors associated with early introduction of solid, semi-solid or soft foods among infants aged 3–5 months, using individual-, household- and community-level determinants. The sample consisted of 2447 infants aged 3–5 months from four Anglophone West African countries: 166 in Ghana, 263 in Liberia, 1658 in Nigeria and 360 in Sierra Leone. Multivariable analyses revealed the individual factors associated with early introduction of solid, semi-solid or soft foods in these countries. These included increased infant’s age, diarrhea, acute respiratory infection and newborns perceived to be small by their mothers. Other predictors of early introduction of solid, semi-solid or soft foods were: mothers with no schooling, young mothers and fathers who worked in an agricultural industry. Public health interventions to improve exclusive breastfeeding practices by discouraging early introduction of solid, semi-solid or soft foods are needed in all 4 countries, targeting especially mothers at risk of introducing solid foods to their infants early.

Factors Associated with Early Introduction of Formula and/or Solid, Semi-Solid or Soft Foods in Seven Francophone West African Countries

The aim of this study was to identify factors associated with early introduction of formula and/or solid, semi-solid or soft foods to infants aged three to five months in seven Francophone West African countries. The sources of data for the analyses were the most recent Demographic and Health Survey datasets of the seven countries, namely Benin (BDHS, 2012), Burkina Faso (BFDHS, 2010), Cote d’Ivoire (CIDHS, 2011–2012), Guinea (GDHS, 2012), Mali (MDHS, 2012–2013), Niger (NDHS, 2012) and Senegal (SDHS, 2010). The study used multiple logistic regression methods to analyse the factors associated with early introduction of complementary feeding using individual-, household- and community-level determinants. The sample was composed of 4158 infants aged between three and five months with: 671 from Benin, 811 from Burkina Faso, 362 from Cote d’Ivoire, 398 from Guinea, 519 from Mali, 767 from Niger and 630 from Senegal. Multiple analyses indicated that in three of the seven countries (Benin, Guinea and Senegal), infants who suffered illnesses, such as diarrhoea and acute respiratory infection, were significantly more likely to be introduced to formula and/or solid, semi-solid or soft foods between the age of three and five months. Other significant factors included infants who: were born in second to fourth position (Benin), whose mothers did not attend any antenatal clinics (Burkina Faso and Niger), were male (Cote d’Ivoire and Senegal), lived in an urban areas (Senegal), or were delivered by traditional birth attendants (Guinea, Niger and Senegal). Programmes to discourage early introduction of formula and/or solid, semi-solid or soft foods in these countries should target the most vulnerable segments of the population in order to improve exclusive breastfeeding practices and reduce infant mortality.