The final analysis included 575 mother-infant pairs for which a complete data were obtained making the response rate 98.5%. From the infants and young children (IYC) included in the study, 286 were males and the remaining 289 were females aged 0-23 months. The median age of the children was 12 months. The mean (±SD) family size of the study participants was 5.4 (±1.9) persons. Nearly two thirds (62%) of the households had 5 or more family members. More than half of households (54%) had two or more children less than 5 years of age. A majority (96%) of the children studied lived in male-headed households. The prevalence of parents with no formal education was higher (72.3%) for mothers than fathers (53.6%). More than half of the mothers (64%) had attended antenatal clinics during their pregnancy. Almost all mothers (99.8%) reported vaginal delivery at their own home (97.6%).
Regarding consumption of extra food during pregnancy and/or lactation of the index child, only 33.4% of mothers reported consumption of additional foods than when they were not pregnant or lactating.
The result of foods and drinks consumed by IYC in the 24 hours preceding the survey showed that the median diet diversity score for the study participants was two. Eighty-six percent of the children had dietary diversity below the minimum dietary diversity recommended by the WHO (< 4 food groups). Proportion of households that reported growing of any vegetable was 102.7%. The majority (93.1%) of mothers in this study reported that IYC consumed complementary foods made from grains, roots, and tubers (specifically corn bread and potato). Most of the children (62%) did not consume any fruits and vegetables during the preceding 24 hours before the survey. Moreover, only 6.3% of children consumed vitamin-A rich fruits and vegetables such as carrot or yellow pumpkin in the 24-hours preceding the survey. In this study, only 1.9% of the infants and young children consumed meat, fish, or poultry and 3.4% consumed eggs in the 24 hours before the survey.
The result from food frequency questionnaire (data not shown) showed that consumption of beef, fish, chicken was not frequent. Children consumed these flesh foods once per month or less throughout the year; whereas cereal-based food, mainly maize, was consumed daily by most of study subjects. Daily consumption of root and tuber, mainly sweet potatoes and potatoes, were reported only for about 2.3% of the children. Fruit and vegetable consumption by children was very minimal (once or twice per week or less) except for very few families (≤ 2.4%) who reported daily consumption of kale, avocado and banana.
The assessment of food security status of households revealed that 21.2% were food secured whereas 6.4%, 34% and 38.4% were mildly, moderately and severely food insecure, respectively.
The prevalence of stunting was higher (43%) for children aged 6-8 months than those 0 to 5 and 9 to 23 months, whereas the corresponding wasting was higher (9.6%) for 9 to 23 months old children than those 0-5 and 6 to 8 months of age (). The highest proportion of underweight (Weight-for-age < -2SD) was for children in the category of 9 to 23 months (29%).
Mean ±SD anthropometric measurements of infant and young children, Boricha District, South Ethiopia, 2011
The majority (93.6%) of the mothers reported initiating breast-feeding their children within 1 hour after birth. The overall rate of EBF for infants under 6 months was 62.4%; however, EBF rates declined from 67.7% in the first month to 60.6% for age 4-5 months. Bottle feeding (specifically bottles with nipples at their tips) is not recommended because improper sanitation associated with bottle-feeding can introduce pathogens to the infant. The present study found that total prevalence of bottle-feeding was 7.5% (2.8%, 7.6% and 8.8% for age groups 0-5, 6-8 and 9-23 months, respectively). Prevalence for timely introduction of complementary foods for 6-8 months old children was 57(72.2%). Compared to the WHO recommendations for IYCF practices, only few (14.4%) of the children were fed with complementary diet of minimum dietary diversity (≥4).
To meet energy requirements WHO [17
] also recommends a minimum of two and three meals per day for breastfeeding IYC between the age 6-8 and 9-23 months, respectively. With reference to these recommendations, the results in the current study showed that 30(38%) of IYC in the age 6-8 months and 147(37%) in the age 9-23 months were reported to receive below the recommended minimum meal frequency. In addition, proportion of IYC who were fed with minimum acceptable diet (an indicator that combines minimum meal frequency and minimum diet diversity) were 4(5.1%) for those in the age group 6-8 months and, 42(10.9%) for those 9-24 months of age.
Based on the WHO IYCF practices indicators, majority (85.6%) of the mothers sub-optimally fed their children, i.e, they did not follow at least one or more of the recommended practices for optimal feeding for their children from 0-24 months of age. And also 40.6% of the mothers reported practicing pre-lacteal feeding.
On multivariable logistic regression after adjustment for other explanatory variables, pre-lacteal feeding was positively associated with child not fed with minimum meal frequency per day, mother who did not receive advice about the complementary feeding and did not follow antenatal care (ANC) during pregnancy. Maternal age during the first child birth > 18 years and mother who breastfed less than eight times per day were negatively associated with pre-lacteal fed (). The birth order of index child was also find to significantly predict EBF practice. Mothers were 5.5 times more likely to practice EBF for their first child than for a child 4th and above birth order (AOR=5.5; 95% CI: 1.09 - 27.72, p< 0.05). The study showed that mothers who did not receive advice about complementary feeding were 2.3 times more likely to practice pre-lacteal feeding (AOR=2.3; 95%CI: 1.29 - 4.16]) than those who did receive information. Mothers who fed their child below minimum meal frequency were twice more likely to practice pre-lacteal fed than their counterpart (AOR= 2.01; 95% CI:1.29 - 3.24); moreover mothers who did not follow ANC during pregnancy were 1.5 times more likely to practice pre-lacteal feeding than those who did follow ANC (AOR=1.5; 95% CI: 0.93 - 2.47). The study also showed that mothers whose age was greater than 18 year during the first child birth were 55% less likely to practice pre-lacteal feeding than their younger counterparts (AOR= 0.45; 95% CI: 0.29 - 0.70). Mothers who breastfed less than eight times per day were 80% less likely to practice pre-lacteal feeding than those who fed more times (AOR=0.2 [95%CI: 0.10,0.39).
A bivariate and multivariate logistic regression output showing the odds of giving Pre-lacteal feeding for infant and young children in Boricha District, South Ethiopia, 2011
Children whose fathers had gotten no formal education were 2.9 times more likely to go through early introduction of complementary food than their counter part ((AOR=2.9; 95% CI: 1.3, 6.5). Moreover, mother who practices bottle feeding were 3.1 times more likely to feed their child early complementary food than their counter parts (AOR=2.9; 95%CI: 1.3, 6.5). Whereas mothers that fed their child pre-lacteal feed were 4.5 times more likely to conduct early introduction of complementary food than their counter parts (AOR=4.5; 95%CI: 2, 9.6).
Households whose land size was less than 0.25 hectare, fathers with no formal education, mothers who reported no increased food consumption during lactation and pregnancy were positively associated with late introduction of complementary food. The finding showed that with land size less than 0.25 hectare were 2 times more likely to practice late introduction of complementary food than their counter parts (AOR=2; 95%CI: 1.1 - 3.3). Households with fathers having no formal education were 2 times more likely to practice late introduction of complementary food than those having formal education (AOR=2; 95%CI: 1.3 - 3.4). Whereas mother that did e not practice the consumption of extra food during pregnancy and lactation were 2 times more likely to start late complementary food than their counter part respectively.
Approximately 86% of mothers in the study areas fed their child below the minimum dietary diversity recommended by WHO (recommended=4, study mean= 2). After adjustment for explanatory variables by logistic regression, HOUSEHOLDs that did not grow vegetables, mother who did not follow ANC and mother who did not consume extra meal during pregnancy or lactation were positively associated with child fed below minimum dietary diversity score. HOUSEHOLD land size greater than 0.25 hectare and later birth order were negatively associated with child fed below minimum dietary score ().
A bivariate and multivariate logistic regression output showing the odds of being “fed below the minimum dietary diversity” for infant and young children in Boricha District, South Ethiopia, 2011
It was found that those households that did not grow vegetables were 2.8 times more likely to feed their child below minimum dietary diversity than their counterparts (AOR=2.8; 95%CI: 1.33 - 6.06). Whereas mothers who did not follow ANC during pregnancy were 2.8 times more likely to fed their child below minimum dietary diversity than those who follow ANC (AOR=2.8; 95%CI: 1.25 - 6.14). The study also showed that mother who did not consume extra food during lactation/pregnancy were 2.6 times more likely to feed their child with low minimum dietary diversity than their counterpart (AOR=2.6; 95%CI: 1.30 - 5.35). On the other hand, children in households with land size > 0.25 hectare and with 4th or above birth order were 73% and 69% less likely to be fed below minimum dietary diversity than their counterparts (AOR=0.265; 95%CI: 0.11 - 0.66) and AOR=0.31; 95%CI: 0.15 - 0.66 respectively) ().
Mothers who did not follow ANC were 1.9 times more likely to feed their child below minimum meal frequency than their counter parts (AOR=1.9; 95% CI: 1.14 - 3.04). Mothers who forced their children to eat more than they take themselves during complementary feeding were 4.2 times more likely to fed below minimum meal frequency than those who simply encouraged the child to eat more (AOR=4.2; 95% CI:1.5 - 11.89). This study also found that children with birth interval less than two years were 2.7 times more likely to be feed below minimum meal frequency than those who were the first born (AOR=2.7; 95%CI:1.15 - 6.17). Mothers > 18 years of age during index child birth were 86% less likely to feed their children with lower meal frequency than their counterparts (AOR=0.14; 95% CI: 0.03 - 0.62) ().
A bivariate and multivariate logistic regression output showing the odds of being fed below the minimum meal frequency for infant and young children in Boricha District, South Ethiopia, 2011
presents logistic regression output on the predictors of stunting. The analysis showed that children of mothers who did not increase food consumption during pregnancy and lactation were 1.6 more likely to be stunted than their counter parts (AOR=1.6; 95%CI: 1.06 - 2.3). The study also revealed that time of complementary food was associated with stunting. Children of mother who had started complementary feeding before six months were 3.2 times more likely to be stunted than their counterparts (AOR=3.2; 95%CI: 1.6 - 6.6). This study also indicated that children who experienced late introduction of complementary food (after 6 months) were 2.3 times more likely to be stunted than their counter parts (AOR=2.3; 95% CI: 1.3, 4.05). The rest of the observed feeding patterns were not significantly associated with stunting.
Bivariate and multivariate logistic regression outputs showing the odds of being stunted for infants and young children (aged 0-23 months) by various feeding pattern characteristics in Boricha District, South Ethiopia, 2011