Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, USA.
Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.
Matern Child Nutr. 2018 Nov;14 Suppl 4(Suppl 4):e12564. doi: 10.1111/mcn.12564. Epub 2017 Nov 17.
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.
有证据表明，补充喂养不足会导致儿童生长不良。然而，在儿童营养不足率仍然高得不可接受的尼泊尔，对于补充喂养的时间趋势和决定因素知之甚少。本研究的目的是使用从 2001 年到 2014 年收集的全国代表性数据，研究尼泊尔 6-23 月龄儿童补充喂养不足的趋势和预测因素。使用来自 2001 年、2006 年和 2011 年尼泊尔人口与健康调查以及 2014 年多指标类集调查的数据，来估计 WHO-UNICEF 四项补充喂养指标的流行率、趋势和预测因素：补充食物的适时引入（INTRO）、最低用餐频率（MMF）、最低饮食多样性（MDD）和最低可接受饮食（MAD）。我们使用多水平逻辑回归模型，确定了个体、家庭和社区各级与这些指标相关的独立因素。2014 年，符合 INTRO、MMF、MDD 和 MAD 标准的儿童的加权比例分别为 72%、82%、36%和 35%，平均年增长率从 1%到 2%不等。儿童年龄增加、母亲教育程度、产前检查和社区获得保健服务的情况，均可独立预测达到 MMF、MDD 和 MAD 的几率增加。这些做法也因生态区和社会文化群体而异。在过去的 15 年中，尼泊尔的补充喂养做法缓慢改善。补充喂养不足的风险存在明显的不平等现象，这需要有针对性地设计和实施方案，以解决尼泊尔最脆弱儿童的不良喂养和营养不良问题。
