AN ASSESSMENT OF NUTRIENT ADEQUACY OF COMPLEMENTARY FOODS FED TO INFANT 6-24 MONTHS IN RURAL COMMUNITIES
ABSTRACT
Background
Mothers and caregivers typically feed infants according to their culture, purchase power and level of awareness with no due diligence to nutritional quality of the diet. Scientific evidence on nutritional adequacy of predominant complementary foods is critical for planning and prioritising interventions. The purpose of the current study was to evaluate the quality of complementary foods and the optimality of complementary feeding practices in Southwest Ethiopia.
Methods
In this cross-sectional study, a stratified multistage sampling procedure was used to sample 433 children, 6–24 months old. A semi-structured questionnaire was used to collect demographic, socio-economic and dietary data. Dietary diversity score was measured using a 24-h dietary recall. Six customary complementary food types were assayed for proximate composition, energy and mineral density using standard methods. Adequacy of the complementary foods in nutrients for complementary feeding purposes was assessed as a ratio between actual composition and recommended composition of complementary foods.
Results
Only 16.1% of the children get the minimum dietary diversity. The children were reported to be fed with cereals & grains (68.8%), discretionary calories (53.6%), protein-rich foods (44.6%), oils and fat (40.5%), vegetables (38.5%), dairy products (17.9%) and fruits (28.1%). The sampled foods contained 4.3–24.4%, 0.9–8.5%, 8.2–11.9%, 27.9–162.6 Kcal/100 g, 168.4–250.4 mg/100 g, 1.8–4.1 mg/100 g and 22.5–42.4 mg/100 g of total carbohydrate, crude fat, protein, energy content, calcium, zinc and iron, respectively. All the complementary food samples predominantly fed to children were not composed of adequate protein, fat, carbohydrate, energy and calcium as recommended for complementary feeding purposes. However, most of the complementary foods are composed of adequate iron and zinc.
Conclusions
The nutrient density and diversity of complementary foods of 6–24-month-old children in the study area were found to be sub-optimal. Upgrading the nutritional composition of the starchy complementary foods should be of highest priority to improve nutrition of the infants and young children.
Background
Complementary feeding refers to supplementing breastfeeding with feeding children aged between 6 and 24 months with a wide range of foods [10]. The period between 6 and 24 months of age is a time of nutritional vulnerability because during this period, nutrients especially micronutrients and energy obtained only from breast milk will not be sufficient to meet the requirements of the child [22]. Ensuring adequate nutrition during the period between 6 and 24 months of age is a major global health priority [10].
Among the immediate causes of undernutrition among children is consumption of too few nutrients [5]. In most low-income countries, including Ethiopia, the beginning of growth faltering coincides with the start of complementary feeding; age-specific malnutrition rates generally increase until about 24 months of age and then level off [20]. The sharp rise in the occurrence of stunting in young children from the age of 6 months is usually associated with suboptimal complementary feeding practices [9]. As children younger than 24 months old do not consume a sufficient amount of food to cover the high nutrient needs for growth and development, food given to them should be of high nutrient density [10].
Theoretically, infants should receive the most nutrient-dense diet in the family. Infants in low-income countries, however, are typically fed with nutrient-poor foods like thin porridges [10]. Complementary foods should contain high-biological value protein, furthermore, vitamins and minerals [25].
The National Nutrition Strategy (NNS) of Ethiopia gives considerable emphasis for nutrition of children younger than 2 years old in particular as nutrition received during this period influences how the children develop, grow and learn now or later. There is no documented evidence of overall complementary feeding practices and adequacy of the complementary foods in nutrients in Jimma Zone. This information is critically needed to be able to judge and plan the mechanisms to upgrade traditional diets. Therefore, this study aimed to evaluate the complementary feeding practices, dietary diversity and nutrient adequacy of complementary foods of children 6–24 months old in Jimma Zone, Southwest Ethiopia.
Methods
Area and subjects
This study was conducted in Jimma Zone, Southwest Ethiopia. The study area is year-round green but unfortunately characterised by household food insecurity [4]. Three districts were purposively selected based on their agricultural production; Omo Nada, Dedo and Mana are cereal, vegetable and cash crop producer areas, respectively.
This study is a component of a more prominent cross-sectional study which assessed the nutritional status and associated factors among children younger than 2 years old. The study population for the original research included all children younger than 2 years old in the study area. A multistage stratified sampling procedure was used to sample 558 children who were 0–24 months old [14]. For the current study, only those children 6–24 months old were included.
Data collection
Data were collected from mothers or caregivers of the infants and children using face-to-face interviews using a semi-structured questionnaire.
Variables
The variables were categorised as dependent and independent variables. The dependent variable was the dietary diversity score of the 6–24-month-old children. The independent variables included several socio-economic and demographic factors like family composition, household size, educational level attained by mothers and fathers, the occupation of mothers and fathers, the wealth of the household and education or training received on health and nutrition. Additionally, the infant- and young child-feeding (IYCF) practices were also assessed.
Measurements
Diet diversity
A single 24-h dietary recall was used to obtain data on dietary diversity. Dietary diversity was assessed with a scale of seven food groups namely cereals and grains, vegetables, fruits, dairy products, oil and fat, protein-rich foods and discretionary calorie foods. Dietary diversity score (DDS) was found to be optimal when a child is fed greater than four food groups per day [23].
Nutrient composition of complementary foods
First, the complementary foods fed to 6–24-month-old children were identified from the questionnaires. Complementary food samples (25 g) were collected from 217 households. The collected food samples were labelled and stored at − 18 °C and eventually transferred to Jimma on the same date of collection. Based on the ingredients used for making the complementary foods, 6 assays were identified. The gross sample was then reduced in size and homogenised to create the laboratory sample [19]. The samples were then analysed for proximate composition (protein, fat, carbohydrate, moisture, ash and fibre), energy content, mineral (iron, zinc, calcium and phosphorous) and anti-nutritional factors (phytate and tannin) following the respective standard methods of analysis [3].
Nutrient adequacy of the complementary foods
Adequacy of the complementary foods in nutrients for complementary feeding purposes was assessed as a ratio between actual composition and recommended composition of complementary foods [13].
Statistical analysis
The data were analysed using Statistical Package for Social Sciences software version 20 (SPSS Inc., Chicago, IL, USA). Descriptive statistics such as percentages were calculated. Bivariate analysis was conducted for the dietary diversity data. P values of less than 0.05 were regarded as statistically significant.
Results
Characteristics of the sample
Table 1 presents the socio-demographic characteristics of the respondents. Fifty four percent of the children in this study were male and 46% were female. Four hundred thirty-three out of 558 children included in the study were aged 6–24 months old. The larger part of the participants 372 (66.7%) were rural residents. A majority of the participants 516 (92.5%) was Muslims in religion. More than half of the children 306 (54.8%) were third and above in their birth order. Additionally, majority of the mothers 360 (64.5%) were aged 20–29 years old. Regarding literacy, larger part of the participants 336 (60.2%) did not attend formal education. A large proportion of the mothers 436 (78.1%) were housewives.Table 1 Description of the study participants (Jimma Zone, Southwest Ethiopia, 2014)
Complementary feeding practices
Table 2 shows the infant- and young child-feeding practices in the study area. The majority (88.9%) of the children were exclusively breastfed, and 75.6% were breastfed up to the age of 2 years. Both early and late initiation of additional food was practised extensively in the study area, but most (82.9%) of the mothers started to give complementary food to their children just at 6 months. However, nearly half of the mothers (53.8%) do not prepare any particular complementary food other than the typical family dish while the rest make some other additional foods of which gruel or Atmit is the predominant one. At the same point, almost all (91.6%) of the mothers do not prepare any particular food to their children during sickness or recovery from disease. The study also signified that 96.7% of the mothers feed their children 3–4 times a day.Table 2 Complementary feeding practices of children 6–24 months old in three districts of Jimma Zone, Southwest Ethiopia, from March to May 2014
Regarding dietary intake, two thirds (68.8%) of the study participants consumed cereal-based gruel (made of barley, oat, teff, wheat, sorghum). Nearly half (44.6%) of the study participants reported that they fed their children with protein-rich food before the survey and (53.6%) of the study subjects consumed discretionary calories in the previous 24 h. Fruits, vegetables and dairy products were consumed by 28.1%, 38.5% and 17.9% of the participants, respectively.
