Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
PLoS One. 2021 May 13;16(5):e0250562. doi: 10.1371/journal.pone.0250562. eCollection 2021.
Childhood undernutrition is a major public health problem especially in low and middle-income countries (LMIC). The prevalence of early introduction of complementary feeding, low meal frequency, and low dietary diversity are frequent in LMICs. The effect of inappropriate complementary feeding practices on the nutritional status of children is not well documented in East African countries including Tanzania. Therefore, this study aimed at determining the effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Tanzania.
A retrospective cohort study was done using the Pasua and Majengo cohorts of mother-child pairs in urban Moshi who were enrolled from 2002 to 2017. About 3355 mother-child pairs were included in the analysis. Appropriate complementary feeding practices were assessed using WHO IYFP indicators such as age at introduction of solid, semi-solid, or soft foods, minimum dietary diversity, and minimum meal frequency. Nutritional status (stunting, wasting, and underweight) was determined. Multilevel modeling was applied to obtain the effect of inappropriate complementary feeding practices on the nutritional status of children and to account for the clustering effect of mothers and children and the correlation of repeated measures within each child.
Majority of the children (91.2%) were given soft/semi-solid/solid foods before six months of age, 40.3percent had low meal frequency, and 74percent had low dietary diversity. Early introduction of complementary food at age 0-1 month was statistically significantly associated with higher risks of wasting and underweight (ARR 2.9, 95%CI 1.3-6.3; and ARR 2.6, 95% CI 1.3-5.1 respectively). Children with low minimum meal frequency had higher risks of stunting, wasting, and underweight (ARR 2.9, 95%CI 2.3-3.6; ARR 1.9, 95%CI 1.5-2.5 and ARR 1.9, 95%CI 1.5-2.4 respectively). Children with low minimum dietary diversity were more likely to be stunted than is the case with their peers who received the minimum dietary diversity (ARR 1.3, 95% CI 1.01-1.6).
There were a high proportion of children, which were fed inappropriately; Inappropriate complementary feeding practices predisposed children to undernutrition. Our study supports the introduction of complementary feeding, providing minimum dietary diversity, and minimum feeding frequency at six months of age as important in improving the nutritional status of the children.
儿童期营养不良是一个重大的公共卫生问题，尤其是在低收入和中等收入国家（LMIC）。在 LMIC 中，早期引入补充食品、低进餐频率和低饮食多样性的情况很常见。在包括坦桑尼亚在内的东非国家，不适当的补充喂养做法对儿童营养状况的影响尚未得到充分记录。因此，本研究旨在确定在坦桑尼亚城市莫希，不适当的补充喂养做法对 6-24 个月大的儿童营养状况的影响。
本研究使用了城市莫希的 Pasua 和 Majengo 母子队列的回顾性队列研究，这些母子队列于 2002 年至 2017 年期间入组。大约有 3355 对母子被纳入分析。使用世卫组织 IYFP 指标评估适当的补充喂养做法，如固体、半固体或软食品的引入年龄、最低饮食多样性和最低进餐频率。确定营养状况（发育迟缓、消瘦和体重不足）。应用多水平模型获得不适当的补充喂养做法对儿童营养状况的影响，并考虑到母亲和儿童的聚类效应以及每个儿童内重复测量的相关性。
大多数儿童（91.2%）在 6 个月前就已经摄入了软/半固体/固体食物，40.3%的儿童进餐频率较低，74%的儿童饮食多样性较低。在 0-1 个月龄时早期引入补充食品与较高的消瘦和体重不足风险呈统计学显著相关（ARR 2.9，95%CI 1.3-6.3；和 ARR 2.6，95%CI 1.3-5.1）。最低进餐频率较低的儿童发育迟缓、消瘦和体重不足的风险较高（ARR 2.9，95%CI 2.3-3.6；ARR 1.9，95%CI 1.5-2.5 和 ARR 1.9，95%CI 1.5-2.4）。最低饮食多样性较低的儿童更有可能出现发育迟缓，而不是与接受最低饮食多样性的同龄人相比（ARR 1.3，95%CI 1.01-1.6）。
有相当比例的儿童喂养不当；不适当的补充喂养做法使儿童容易出现营养不良。我们的研究支持在 6 个月大时引入补充食品、提供最低饮食多样性和最低喂养频率，这对改善儿童的营养状况非常重要。
