Childhood undernutrition contributes significantly to morbidity and mortality in the first few years of life, and increases risk of chronic diseases in adulthood. The majority of growth faltering in children occurs between the ages of 3 and 24 months, likely due to sub-optimal infant and young child feeding (IYCF) practices, recurrent infections and inadequate water and sanitation facilities. Using data from the evaluation of a community-based nutrition program in rural Bangladesh, we identified determinants of IYCF practices and their impact on child growth, and assessed whether providing nutrition messages to care-givers can result in improved growth for children < 2 years old. Twenty-four hundred pregnant women were recruited into a prospective cohort, with follow-up at infant age 3, 9, 16 and 24 months.
Study 1 assessed the relationship between maternal knowledge and attitudes regarding complementary feeding (CF) and timing of CF initiation. We observed that mothers with the most positive attitudes towards CF were less likely to initiate timely CF. Surprisingly, knowledge was not associated with timely CF initiation.
In study 2 we determined the association between household food security (HHFS) and infant diet. We observed that although HHFS was a significant predictor of dietary diversity in infants, diet quality was poor for children from even the more food-secure households.
Our third study focused on the associations between IYCF practices and infant growth. We found that neither exclusive breastfeeding (EBF) at age 3 months, nor timely initiation of CF were associated with subsequent growth. Only quality of diet at age 9 months was significantly associated with infant growth at 9, 16 and 24 months of age.
Our final study assessed the impact of a nutrition program on IYCF practices and infant growth. The program was successful in improving the quality of infant diet at 9 months, but not rates of EBF at 3 months or timely CF initiation. The intervention was also not associated with improvements in infant growth.
Taken together, these studies identify the determinants of age-specific IYCF practices in rural Bangladesh, and contribute to the longitudinal evidence linking these practices to child growth.
Table of Contents
Chapter 1: Background and significance 1
Chapter 2: Maternal knowledge and attitudes in relation to complementary feeding initiation in rural Bangladesh 11
Chapter 3: Household food security and infant feeding practices in rural Bangladesh 30
Chapter 4: Minimum acceptable diet at 9 months but not exclusive breastfeeding at 3 months or timely complementary feeding initiation is predictive of infant growth in rural Bangladesh 50
Chapter 5: A prospective cohort-based evaluation of a nutrition education program for improving infant feeding practices and growth in rural Bangladesh 75
Chapter 6: Dissertation in context - contributions, limitations and implications 102
About this Dissertation
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