Improving diet quality among infants and young children

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Improving Diet Quality Among Infants and Young Children: Challenges and Potential Solutions, by Dr. Purnima Menon, IFPRI

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Improving diet quality among infants and young children

  1. 1. Improving Diet Quality Among Infants and Young Children: Challenges and Potential Solutions Purnima Menon International Food Policy Research Institute Workshop on The Feed the Future Zone in the South and the Rest of Bangladesh: A Comparison of Food Security Aspects 16 January 2013 Dhaka 1
  2. 2. Why care about diet quality?• Diet quality (as measured by proxy indicators such a diversity) is associated with better nutritional outcomes for children• Diet quality for young children, especially diversity, is known to be a problem in most developing countries Zongrone et al., Public Health Nutrition, 2012 2
  3. 3. IYCF practices in the FTF zone compared to the rest of the countryConsumption of iron-rich or iron-fortified foods Minimum acceptable diet Minimum meal frequency BDHS Minimum dietary diversity (4+ food groups) BIHS FTF Introduction of solid, semi-solid or soft foods Continued breastfeeding at 1 year Exclusive breastfeeding under 6 months 0 20 40 60 80 100 120 3
  4. 4. Timely introduction of high nutrient-value foods is low (BIHS sample) Before After 6-8.9 mo 6 mo 9 moComplementary food % % % Water 69.8 29.0 1.2 Other non-breast milk liquids (e.g. sugar/glucose water, 48.3 49.0 2.8 tea, fruit juice, etc.) Cow or goat milk 37.4 49.9 12.7 Sooji, rice gruel, etc. 27.9 65.9 6.3 Semi-solid foods (e.g. soft rice, mashed potato, ripe 12.5 76.9 10.7 banana, etc.) Solid foods (e.g. rice, wheat, puffed or pressed rice, etc.) 7.5 67.5 25.0 Fish 5.9 65.3 28.7 Meat 5.0 60.8 34.2 Eggs 7.2 71.9 20.9 Legumes 6.3 72.5 21.2 Green vegetables 6.0 75.0 19.0 Snack foods (e.g. chips) 3.3 54.2 42.5 4
  5. 5. Diet diversity is especially low for 6-8 mo old infants (BIHS sample; 24-hr food group recall)Items fed to children aged 6-8 months based upon 24 hour recall % (N = 115)Liquids Breast milk 98.2 Water 87.5 Prepared baby formula 16.1 Any other kind of milk (e.g. powder, cow, goat, etc.) 31.8 Fruit juice (homemade) 8.0 Fruit juice (purchased) 1.2 Water-based liquids (e.g. teas, sugar water, coffee, etc.) 42.6Food groups Grains, roots, and tubers 70.3 Legumes and nuts 8.3 Dairy (e.g. milk, yogurt, cheese) 42.9 Flesh foods (e.g. meat, fish, poultry, and liver/organ meats) 5.3 Eggs 8.3 Vitamin A-rich fruits and vegetables 16.2 Other fruits and vegetables 10.4 5
  6. 6. Percentage 0 20 40 80 60 Grains, roots, and tubers Legumes and nutsDairy (e.g. milk,yogurt, cheese) Boys Flesh foods(e.g. meat, fish, Girls poultry, and… Eggs TOTAL Vitamin A-rich fruits and vegetablesOther fruits and vegetables for children 6-23 months old (BIHS sample) Types of food fed to children is not different by gender6
  7. 7. % of children 6-23 months old achieving minimum diet diversity, by division and wealth 100 90 80 70% 60 Division Wealth group 50 40 30 20 10 0 7
  8. 8. Use of micronutrient supplements (BIHS) 100.0 90.0 80.0 70.0 60.0 50.0% 40.0 30.0 20.0 10.0 0.0 For children Mother took aged 6-23 Diarrhea: oral iron Mother was months, child rehydration tablets/supplem given vitamin A Diarrhea: zinc received a solution (ORS) ents during capsule after tablets. capsule of that was recent delivery vitamin A in last purchased. pregnancy 6 months 8 Series1 56.0 23.6 70.7 86.7 21.9
  9. 9. Maternal nutrition knowledge is variable (BIHS) 100.0 90.0 80.0 70.0 60.0 50.0% 40.0 30.0 20.0 10.0 0.0 Baby should be Baby should be Iron deficiency can Handwashing before breastfed breastfed colostrum impair child growth feeding a child. immediately or <1 after birth and development hour after birth 9
  10. 10. Awareness about micronutrient powders (BIHS) is especially low Percentage of mothers under-twos who have heard about MNPs, by SES (BIHS)100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1 (lowest) 2 3 4 5 (highest) 10
  11. 11. What are some solutions?• Improving diet quality requires investments in: – Behavior change communication – Shaping social norms – Addressing food insecurity (often a predictor of diet quality for young children)• A challenge is implementing interventions to address this issue at scale!• IFPRI’s evaluation of Alive & Thrive interventions implemented by BRAC and FHI360 are shedding light on this 12
  12. 12. INSIGHTS FROM ALIVE & THRIVEEVALUATION RESEARCH BY IFPRI ON POTENTIAL SOLUTIONS TOIMPROVING IYCF AND DIET QUALITY 13
  13. 13. A&T evaluation design 60 Rural upazilas (50 + 10) 20 (paired) rural EHC upazilas Process 10 upazilas 10 upazilas evaluationA&T Intensive A&T Non-intensive Both qualitative Baseline Survey (April-July 2010) and FHW Survey (September-October 2011) quantitative Process Evaluation Survey (June-July 2012) A&T HH Survey(April-July 2013) A&T Endline Survey (April-July 2014) 14
  14. 14. Early impacts of Alive & Thrive’s interventions on infant and young child feeding practices (WHO indicators) A&T (2012) Non-A&T (2012) Baseline (2010) Iron food (6-23 mo) ***Min acceptable diet (6-23 mo) * Min meal freq (6-23 mo) Min diet diversity 6-23 mo ** Solid/semi-solids in 6-8.9 mo Continued BF 12-15 mo EBF 0-5.9 mo Early initiation 0 10 20 30 40% 50 60 70 80 90 100 * p < 0.05, ** p < 0.01, *** p < 0.001 15 Non-A&T= Non-intensive
  15. 15. More households in A&T areas have heard complementary feeding and MNP messages Baseline (2010) A&T Intensive (2012) A&T Non-Intensive (2012) 100 80Percent 60 40 20 0 Feed mashed family Feeding animal source Cook childrens food Add Multiple Nutrient food to children aged > foods to children aged with oil Powder (MNP) to the 6 months > 6 months These 2 behaviors – use childs food MNPs - are of oil and mainly promoted by FHWs, not the media campaign
  16. 16. Health worker visits to HH is high in A&T areas SS/PS SK PK 100100 100 A&T Area 90 A&T Area 90 Non-A&T Area 90 Non-A&T Area 80 A&T Area 80 80 70 70 70 60 60 60 50 50 50 40 40 40 30 30 30 20 20 20 10 10 10 0 0 Ever had HH Ever had HH 0 Ever had HH visit Ever had HH visit visit by SS/PS visit by SS/PS Ever had HH Ever had HH by SK (unaided by SK (aided (unaided (aided recall) visit by PK visit by PK recall) recall) recall) (unaided (aided recall) Non-A&T= Non-intensive recall)
  17. 17. Mass media campaign: recall of TVCs among total sample in A&T evaluation sample 60 Early initiation of breast 50 feeding Exclusive breast feeding 40 Percent 30 Animal source food after 6 months 20 Poor appetite 10 Frequency of 0 complementary feeding A&T Intensive Areas A&T Non-Intensive The house is on fire Areas 18
  18. 18. INSIGHTS FROM THE BANGLADESHINTEGRATED HOUSEHOLD SURVEY ON ACCESS TO KEY INTERVENTION PLATFORMS 19
  19. 19. Exposure to counseling by health workers is quite low Literate Illiterate TOTAL mother mother (n=979) (N = 886) (N = 93) % % % Have been visited at home by any health worker 25.8 26.5 19.2 in the last 6 months Visited by a health worker ≥3 times in the last 6 43.6 43.5 45.5 months (among those visited in the last 6 mo) Received advice from health worker about 59.2 59.7 52.6 feeding the child during last visit (among those visited in the last 6 mo) 20
  20. 20. Exposure and recall of national IYCF communications campaign (BIHS, all female respondents, N=5503) Recalled seeing this television advertisement Correctly recalled any of the message(s) 27.8 22.8 24.5 22.7 21.8 20.7Percentage 17.3 17.7 16.2 14.3 15.3 11.4 Advertisement Advertisement Advertisement Advertisement Advertisement Advertisement about a about about a house about cooking about sports about child newborn baby breastfeeding on fire ("House fish ("Mother ("Tumpa wins feeding ("Baby ("A mother of ("Father brings is on fire") cooking fish") a prize") goes to sleep a newborn tinned milk for without baby") baby") eating") 21
  21. 21. Summary• FTF and BIHS data affirm the significant challenge of ensuring nutritionally adequate infant and young child diets• Poor feeding practices and low use of micronutrient supplements  poor nutrient quality of diets, overall• Early results from evaluation research suggest interventions such as those implemented by Alive & Thrive have potential to improve diet quality through high quality, high coverage interventions• A significant challenge, seen in the BIHS, is that overall access to interventions (mass media and health worker counseling) that can improve IYCF is currently lower than desirable 22
  22. 22. Next steps• Further disaggregated descriptive analysis, not just by age, gender and SES, but also other maternal and household characteristics• Empirical analyses and research papers on: – Predictors of anthropometric outcomes and IYCF practices – Links between agriculture and nutritional outcomes – Other 23

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