Validation of selected 2021 infant and young child feeding indicators for appropriate complementary feeding in relation to dietary adequacy and anthropometric status

@#Introduction: With the new set of 2021 infant and young child feeding (IYCF) indicators released by WHO and UNICEF, there is a need for its validation in the Philippine setting. The study evaluated the validity of cut-off points used for minimum dietary diversity and minimum feeding frequency in terms of micronutrient and energy intake adequacy, respectively, and minimum acceptable diet (MAD) in relation to anthropometric status. Methods: The study covered 8360 infants and young children aged 6-23.9 months with complete information on IYCF, anthropometric measurements, maternal information, and household characteristics from the 2018-2019 Expanded National Nutrition Survey (ENNS). Bivariate and correlation analyses using STATA version 15 (Corp LLC, Texas, USA 2017) were performed to determine the association of specific IYCF indicators: dietary diversity and feeding frequency with nutrient and energy intake adequacy, and MAD with anthropometric status. Sensitivity and specificity analyses were performed to evaluate the accuracy of dietary diversity score (DDS) and feeding frequency in identifying children with adequate nutrient and energy intakes, respectively. Results: Significant associations were found between DDS and micronutrient adequacy, and between feeding frequency and energy intake adequacy, regardless of breastfeeding status. A DDS of 5 and 6 and feeding frequency of 4-5 and 8 maximised sensitivity and specificity in identifying breastfed and non-breastfed children meeting 100% nutrient and energy adequacy, respectively. Conclusion: The selected 2021 complementary feeding indicators are practical guidelines to reflect dietary adequacy, but may not capture the entire process related to nutritional outcomes, especially stunting.

Association of household food security and dietary diversity of mother-child pairs in the Philippines

@#Introduction: The majority of Filipino households experience food insecurity. Mothers and children are among the population groups suffering from poor diet quality. This study aimed to determine the extent of the association of household food security (HFS) to mothers’ and children’s dietary diversity score (DDS), and to identify the significant factors associated with meeting the DDS of these vulnerable groups. Methods: The study was a cross-sectional, population-based study utilising secondary data from the 2015 Updating Survey. From a total of 6,692 mother-child pairs, the association between HFS and meeting the DDS of mothers and children, as well as the potential predictors for meeting the DDS were tested using descriptive and logistic regression analyses. Results: The findings showed that HFS was significantly associated with meeting the DDS of mothers and children aged 6-36 months (p<0.001). The proportion of meeting the DDS among mothers and children was significantly higher in food-secure than in food-insecure households (20.7% vs. 14.4%). Furthermore, meeting the DDS decreased with increasing levels of food insecurity. Household food security status, education background, employment, child’s age, and wealth status were significantly associated with meeting the DDS. Conclusion: This study showed the extent of how food security was associated with meeting the DDS of mothers, children, and mother-child pairs, and the factors associated with meeting the DDS. Results can be used to strengthen the formulation of appropriate, evidence-based policies to address household food insecurity and low DDS among mothers and young children.

Impact of COVID-19 in the participation of Filipino children 0-12 years old to nutrition-specific programs and their mothers' knowledge based on a Rapid Nutrition Assessment Survey

Background@#As the SARS-CoV-2 virus (COVID-19) continues to affect the capacity of the health system to deliver essential nutrition and health services, many countries, especially the low- and middle-income countries, including the Philippines, are beset with addressing undernutrition and micronutrient deficiencies among children. @*Objective@#The rapid nutrition assessment survey (RNAS) was conducted in selected areas in the Philippines to provide evidence of the effect of the COVID-19 pandemic on children's participation in the nutrition services and their mothers' knowledge level on nutrition. @*Methodology@#The RNAS was a cross-sectional survey conducted through phone interviews in nine (9) selected areas in the Philippines. A total of 7,092 children aged 0 to 12 years were included in the survey, of which 5,239 mothers and caregivers were interviewed regarding nutrition program participation of their children, and their knowledge on nutrition. @*Results@#A significant decline in children's participation in the Operation Timbang (OPT) Plus (83.0% vs. 51.1%), Vitamin A supplementation (65.4% vs. 54.9%), supplementary feeding (21.6% vs. 11.9%), and deworming (60.4% vs. 11.9%) was recorded during the COVID-19 pandemic based on RNAS as compared to the pre-pandemic period using the 2019 Expanded National Nutrition Survey (ENNS). The most commonly cited reasons for health service disruptions include: child did not visit health centers due to fear of infection, community health workers did not visit the child at home, and no available health workers in the facility. Stunting among children was more likely to be perceived by food insecure (19.7% vs 14.4%; p <0.001) and poor (22.1% vs 16.6%; p<0.000) mothers or caregivers than their counterpart mothers from food secure and rich households. @*Conclusion@#With prolonged limited access to health and nutrition services, children, particularly those from poor households, are at risk of hunger, malnutrition, and consequently, of not developing their full potential. Findings can guide efforts to ensure the continuity of essential health and nutrition services towards improving maternal knowledge and promotion of child health and nutrition during the COVID-19 outbreak and crisis recovery period.

Risk factors of stunting during the complementary feeding period 6-23 months in the Philippines

@#Introduction: Stunting persists as a public health problem in the Philippines, affecting 30% of under-five children. This study aimed to identify the drivers of stunting in young Filipino children aged 6-23 months. Methods: Data were extracted from the cross-sectional Updating Survey conducted in 2015 by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST). Potential predictors of stunting, which were categorised into childrelated characteristics, feeding practices, maternal socio-demographic status and health practices, and household economic and food security status, were examined using descriptive and regression analyses. Results: Of the 2,275 children aged 6-23 months, 18.7% were stunted and 8.3% were severely stunted. The risk of stunting increased significantly among older children aged 12-23 months (relative risk ratio, RRR 3.04), males within 6-23 months of age (RRR 1.99), and low-birth-weight infants (RRR 2.19). Children born from teenage mothers (RRR 1.90), mothers with short stature (RRR 2.33), and mothers with low education (RRR 1.59) posed higher risks of becoming stunted relative to their counterparts. Mothers with >4 children (RRR 2.44), coming from the poorest households (RRR 4.27), having untimely introduction of complementary foods (RRR 4.44), and not meeting the minimum meal frequency (RRR 2.30) increased the risks of severe stunting. Conclusion: The study illustrated the multi-factorial nature of stunting among Filipino children aged 6-23 months old. Therefore, a multi-sectoral approach is needed to address the underlying factors of stunting among young Filipino children to help achieve the country’s nutrition targets by 2025.