International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia.
Front Public Health. 2023 Jan 19;10:1014281. doi: 10.3389/fpubh.2022.1014281. eCollection 2022.
Suboptimal complementary feeding contributes to undernutrition in children aged 6-23 months in low- and middle-income countries like Bangladesh. Multifaceted interventions have been taken to improve complementary feeding practices, but there is limited evidence about the effect of home visits by community health workers (CHWs) on complementary feeding practices of the caregivers of children.
We collated data from the baseline and the corresponding follow-up survey done as part of an evaluation of Bangladesh Maternal, Infant and Young Child Nutrition (MIYCN) programme. We collected data on complementary feeding practices using a 24-h recall questionnaire. Age-appropriate dietary diversity, minimum meal frequency, and minimum acceptable diet were assessed based on recommended food consumption as per child's age. To understand the effect of CHWs' visits on complementary feeding practices, we performed Generalized Estimating Equation (GEE) procedure for dealing with correlated data and adjusted other covariates.
A total of 758 and 745 caregivers of children aged 6-23 months participated in the baseline and follow-up survey, respectively. Complementary feeding practices were improved in 1 year of programme implementation; dietary diversity increased from 46 to 54%, minimum meal frequency from 82 to 91%, and minimum acceptable diet from 41 to 53%. Caregivers of children who had received the visit of CHWs in the last 12 months prior to the day of the follow-up survey were more likely (AOR 1.51; 95% CI 1.10-2.10) to maintain dietary diversity in their children's feeding practices than the caregivers who had not received a CHW visit in the last 12 months. The likelihood of maintaining a minimum acceptable diet in feeding practices was 1.57 times higher (AOR 1.57; 95% CI 1.14-2.17) among the caregivers who were exposed to the visits of the CHWs in the last 12 months compared to the caregivers who were not exposed to the CHW's visits in the last 12 months.
Integration of promotional activities of complementary feeding practices into the mainstream nutrition programme can be instrumental in optimizing complementary feeding practices among the caregivers of the under-five children. However, home visits by CHWs should be prioritized in such an integrated programme.
在孟加拉国等中低收入国家，6-23 月龄儿童的辅食添加不理想，导致其营养不足。为改善辅食添加行为，已采取多方面措施，但有关社区卫生工作者（CHW）家访对儿童照护者辅食添加行为影响的证据有限。
我们整合了基线数据和作为孟加拉国母婴和儿童营养（MIYCN）方案评估一部分进行的相应随访调查的数据。我们使用 24 小时回顾问卷收集辅食添加行为数据。根据儿童年龄建议的食物摄入量，评估了年龄适宜的饮食多样性、最低进餐频率和最低可接受饮食。为了解 CHW 家访对辅食添加行为的影响，我们采用广义估计方程（GEE）程序处理相关数据，并调整了其他协变量。
共有 758 名和 745 名 6-23 月龄儿童的照护者分别参加了基线和随访调查。在方案实施的 1 年内，辅食添加行为得到改善；饮食多样性从 46%增加到 54%，最低进餐频率从 82%增加到 91%，最低可接受饮食从 41%增加到 53%。在随访调查之日前的 12 个月内接受过 CHW 家访的儿童照护者，其子女的喂养实践中维持饮食多样性的可能性更大（比值比 1.51；95%置信区间 1.10-2.10），而在过去 12 个月内未接受过 CHW 家访的儿童照护者则较小。在过去 12 个月内接受过 CHW 家访的照护者，其子女喂养实践中维持最低可接受饮食的可能性是未接受过 CHW 家访的照护者的 1.57 倍（比值比 1.57；95%置信区间 1.14-2.17）。
将辅食添加实践的宣传活动纳入主流营养方案，可以促进 5 岁以下儿童照护者优化辅食添加行为。然而，在这种综合方案中，应优先考虑 CHW 的家访。
