Age‑Appropriate Feeding Practices and Nutritional Status of Slum‑Dwelling Young Children in Kolkata during COVID‑19 Pandemic: A Cross‑Sectional Study

Introduction: COVID‑19 pandemic was postulated to affect the infant and young child feeding (IYCF) practices and their nutritional status. This study was planned to assess IYCF practices and nutritional status of infant and young children residing in slum areas and their association with selected background characteristics. Materials and Methods: Acommunity‑based, cross‑sectional study was conducted in slums of Kolkata Municipal Corporation among 161 mother–child dyads from October to December 2020. After obtaining informed consent, mothers were interviewed to collect information about their socioeconomic status, hardship faced during pandemic, and IYCF practices of their children using indicators proposed by the World Health Organization and Government of India. Weight and height were measured using the standard operating protocol. The proportion was used to express descriptive statistics. Binary logistic regression models were used for calculating the adjusted odds ratio (AOR) using PSPP (v 1.20). Results: Only 64 (39.8%) children received age‑appropriate feeding; 73 (45.3%) had single/multiple anthropometric failure(s). Reduction of family income was reported by 142 (88.2%) respondents. Children aged 6–8 months (AOR = 17.08, 6.43–45.42) were more likely to not have appropriate feeding. Association of female gender (AOR = 2.00, 1.01–4.00), maternal education less than middle class (AOR = 2.58, 1.22–5.46), and lack of appropriate feeding (AOR = 2.57, 1.08–6.12) were statistically significant with the presence of anthropometric failure. Conclusions: The study revealed a dismal scenario of child feeding and nutritional status of young children in the urban slums of Kolkata. Pandemic and imposed restrictions hit the families hard by reducing income and increasing food‑related costs.

Prácticas de alimentación infantil de cuidadores principales, conducta alimentaria y estado nutricional de preescolares en Chile / Child feeding practices of primary caregivers, eating behavior and nutritional status of preschoolers in Chile

Resumen Este estudio tuvo como objetivo conocer la relación entre estado nutricional, prácticas de alimentación del cuidador y conducta alimentaria en preescolares de una comuna del centro sur de Chile. La muestra estuvo compuesta por 249 preescolares y sus cuidadores principales. Se encontró una relación positiva entre índice de masa corporal (IMC) del niño y preocupación por el peso del niño (r = .51, p < .01), así como entre IMC del niño y alimentación restrictiva del cuidador (r = .20, p < .01). Se encontraron relaciones débiles aunque significativas entre estado nutricional (IMC y porcentaje de grasa corporal) y conducta alimentaria en niños. Análisis de correlaciones canónicas indicaron que las variables agrupadas de prácticas de alimentación infantil se relacionaron positivamente con el estado nutricional del niño (ρ3 = .54, < .001). Adicionalmente, se encontró que la preocupación por el peso del niño mediaba parcialmente la relación entre restricción alimentaria e IMC (IC 95% efecto indirecto "ab" [.02; .13]) y entre restricción y porcentaje de grasa corporal (IC 95% efecto indirecto "ab" [.06; .50]). Las actitudes y prácticas de alimentación infantil de los cuidadores principales, particularmente la preocupación por el peso del niño y la restricción en la alimentación juegan un rol crítico en la mantención y manejo de la obesidad en preescolares. Se exploran las implicancias prácticas de estos hallazgos.

Abstract The objective of this research was to determine the relationship between child nutritional status, feeding practices of the primary caregiver and the child eating behavior of preschoolers in a community in south-central Chile. The sample comprised 249 preschool children from three public and semi-public schools and their primary caregivers. A positive relationship was found between body mass index (BMI) and weight concern (r = .51, p < .01) and restrictive feeding practice (r = .20, p < .01). Significant but weak relationship existed between BMI, body fat percentage and child eating behavior. Canonical correlation analysis indicated that child feeding practices as a group were related to nutritional status of children. Additionally, weight concerns partially mediate the relationship between restrictive feeding and BMI (CI 95% indirect effect "ab" [.02; .13]) and body fat percentage (IC 95% efecto indirecto "ab" [.06; .50]). Child feeding practices of the primary caregivers, particularly weight concern and restrictive feeding play an important role in the management of the preschool children obesity.

Study of Infant Feeding Practices in Rural Area in Goa

Background: Suboptimal feeding practices during the infancy increase the risk of death, illness, and malnutrition. Despiteoverwhelming evidence of the benefits of exclusive breastfeeding, only about 40% babies under 6 months are exclusivelybreastfed, due to the lack of understanding of optimal feeding practices and lack of support from health service providers,community members, and families; babies who are not exclusively breastfed in the early months have a higher risk of death,especially from infection. The Lancet’s 2003 child survival series identified that exclusive breastfeeding could save up to 1.3million children worldwide. This essential intervention involves the early initiation of breastfeeding and ensuring that the mothergives only breastmilk and no other food or fluids during the first 6 months of life. Undernutrition of children is an importantcontributor to the deaths of 10.5 million children globally each year.Aims and Objectives: The present study seeks to estimate the proportion of mothers carrying out age-appropriate infantfeeding practices. Besides, the present study was conducted to study factors associated with infant feeding practices andreasons preventing exclusive breastfeeding in infants.Materials and Methods: A cross-sectional community-based study was conducted in the field practice area of Rural Health andTraining Centre, Mandur, Goa, from February 2019 to August 2019. Recruitment of study population was done by a systematicrandom sampling method and study population comprised of mothers with infants between 9 months and 1 year. A structuredquestionnaire was used to collect data in a face to face interview with the mother.Results: In the present study, 150 infants aged 9 months to 1 year were recruited. It was observed that exclusive breastfeedingup to 6 months was carried out in 94 infants (62.66%). Early initiation of breastfeeding was carried out in 37 infants (24.7%).Weaning of infants by 6 months was started in 72 infants (48.18%). Exclusive breastfeeding of infants was found to bestatistically significantly associated with mother’s occupation (≥2 = 27.152; P = 0.00019), religion (≥2 = 12.19; P = 0.015), andage (≥2 = 25.4; P = 0.0002).Conclusions: Suboptimal feeding practices during the infancy increase the risk of death, illness, and malnutrition. It is imperativeto educate mothers on infant and young child feeding practices and create awareness within communities to achieve optimalgrowth and development of infants.

Actitudes y prácticas de alimentación de cuidadores principales de escolares de origen Mapuche y no Mapuche según estado nutricional / Attitudes and feeding practices of primary caregivers of Mapuche and non-Mapuche schoolchildren according to nutritional status

Este estudio tuvo como objetivo asociar actitudes y prácticas de alimentación infantil de cuidadores con el estado nutricional de niños de origen mapuche y no mapuche. Participaron 200 escolares de primero a cuarto básico y sus cuidadores. Se realizó medición de peso y talla en los niños, y cuidadores respondieron el Child Feeding Questionnaire y un instrumento de caracterización sociodemográfica. Los resultados indicaron presencia de sobrepeso y obesidad en 56% del total de niños evaluados, cifra superior al promedio nacional, con un porcentaje significativamente superior (p≤0.001) en el grupo de origen mapuche (71,9%). Las asociaciones más fuertes del puntaje z de IMC del niño se encontraron con peso percibido d (r= 0,56, p= <0,001) y preocupación por el peso (r= 0,34, p= <0,001). Lo mismo ocurrió al segmentar la muestra por etnia. La única actitud que demostró diferencias entre grupos fue la responsabilidad percibida (p=0,018), resultando inferior en el grupo mapuche. No obstante, las diferencias según etnia, ésta no resultó predictora del estado nutricional del niño, pero sí el peso percibido (β= 3,778, p< 0,001) y la preocupación por el peso (β= 0,944, p= 0,018). Lo anterior refuerza el rol de actitudes y prácticas de padres y cuidadores en el estado nutricional del niño con independencia de los factores culturales implicados.

This study aims to associate child feeding attitudes and practices of caregivers with the nutritional status of Mapuche and non-Mapuche children. Two hundred schoolchildren from first to fourth grade and their caregivers participated. Measurement of weight and height was performed in children; caregivers completed the Child Feeding Questionnaire and a sociodemographic characterization instrument. Fifty six percent of the children assessed were overweight or obese, with a significantly higher percentage (p≤0,001) in the Mapuche group (71.9%). Child's BMI z-score was strongly related with perceived weight (r= 0,56 p= <0.001) and weight concern (r= 0,34, p= <0,001). The same results were found when segmenting the sample by ethnicity. The only attitude that showed differences between groups was perceived responsibility (p= 0,018), being lower in the Mapuche group. Despite the differences according to ethnicity, this variable was not predictive of the nutritional status of the child, unlike perceived weight (β= 3,778, p<0,001) and weight concern (β= 0,944, p= 0,018). These findings reinforce the role of attitudes and practices of parents and caregivers in the nutritional status of the child, regardless of the cultural factors involved.

Overweight and Obesity Among Children: A Relationship Between Maternal Beliefs and Feeding Practices With Children’s Body Mass Index-for-Age in Bandar and Jugra Kuala Langat Selangor

@#Introduction: Childhood obesity is one of the major public concerns as prevalence was showing an increasing trend in Malaysia. This study aimed to determine the associations between maternal beliefs, attitudes and feeding practices with children’s Body Mass Index-for-age (BMI-for-age). Method: A cross-sectional study was carried out in Bandar and Jugra, Kuala Langat, Selangor in two-phase. The first phase was conducted to determine the prevalence of children’s body weight status involving 209 pairs of mothers and children. The second phase of the study aims to determine the socio-demographic characteristics, maternal beliefs, maternal attitudes and feeding practices with childhood obesity involving 148 pairs of mothers and children whose BMI-for-age are normal, overweight and obese only. A set of self-administered questionnaire was answered by the mothers and anthropometric measurements of children were taken. Results: Overall, about 24.9% of the children were overweight and obese. Maternal employment status (X2 = 9.135, p<0.05), perceived child weight status (r=0.267, p<0.05) and food restriction (r=0.186, p<0.05) were positively correlated with children’s BMI-for-age. The pressure to eat (r= -0.177, p<0.05) was negatively associated with children’s BMI-for-age. From multiple linear regression, maternal employment status, perceived child weight status and pressure to eat was shown to be factors associated with children’s BMI-for-age. Conclusion: In conclusion, the findings showed that maternal employment status, perceived on child weight status, restriction on food and pressure to eat were linked to children’s BMI-for-age. Therefore, mothers should be educated on appropriate feeding practices to help to maintain healthy BMI-for-age among younger children.

Retrospective Child Feeding Practices and Obesity Risk among Young adults

@#Introduction: Early environmental factors play a major role in shaping the health of an individual. Dietary preference and habits shaped by parental feeding practice during childhood are likely to persist into adulthood which further determines body weights status. This study aimed to determine the retrospective child feeding practices associated with obesity risk in young adults. Methods: This was a retrospective cross-sectional study with 176 university students in Kuala Lumpur. Data of maternal age, gestational age and feeding practices were collected retrospectively using Child Feeding Questionnaire (CFQ). Subject’s current socio-demographic data was collected and anthropometric measurements were taken using standard protocol. Results: Around 22% of the subjects were overweight/ obese. No significant association was found between child feeding practices with maternal age. A significant association (p<0.05) was found between pressure to eat with gestational age, in which parent with preterm (<37 weeks gestation) and full-term subjects were more likely to pressure their child to eat as compared to post-term subjects (>42 weeks gestation). Obesity risk in young adults was higher among parents who viewed themselves as overweight (aOR=2.783; CI=1.631-4.749) and who viewed their child as overweight from birth to primary school (aOR= 1.512; CI=1.080-2.116). Young adults that were pressured by their parents to eat during childhood were less likely to be obese (aOR=0.785; CI=0.621-0.992). Conclusion: Parental influences on child feeding practices were linked to obesity risk in young adulthood. Parent education on child feeding practices is needed to maintain healthy weight status of their child from young to later life.

Prevalence and factors affecting early initiation of breastfeeding in rural areas of Dibrugarh district, Assam

Background: Early or timely initiation of breastfeeding, specifically within 1 hour of birth has benefits for survival and beyond and it is recommended by the World Health Organization. Breastfeeding initiation after the first hour of birth doubles the risk of neonatal mortality. The present study has been conducted to estimate the prevalence and determine the factors affecting early initiation of breastfeeding in rural areas of Dibrugarh, district, Assam. Methods: Community based cross sectional study from May 2017 to April 2018 among mothers having children in the age group 0 to 23 months in the rural areas of Dibrugarh district. The sample size calculated for the study was 360 children. Results: The results were analyzed for 334 children. Prevalence of early initiation of breastfeeding was found to be 54.8%. On multivariate regression analysis the occupation and education of mothers, number of antenatal checkup visits, type of delivery and religion were found to be independently associated with early initiation of breastfeeding. Conclusions: This study reveals that the early initiation of breast feeding is lower in rural areas of Dibrugarh district. The findings clearly highlight the importance of imparting health education to family members and mothers right from antenatal period on infant and child feeding practices.

Prevailing breast feeding practices of infants attending paediatric out-patient department.

Background: Objectives of current study were to know the prevailing infant feeding practices in infants and to identify the problems affecting infant and young child feeding practices and to analyze the environmental factors influence the mothers, families and caregivers in infant feeding. Methods: The present study is a hospital based observation study. A total of 501 mothers and their infants attending new born paediatric OPD, immunization clinic of department of paediatrics for various reasons of health care were recruited for the study after their informed consent and institutional ethical clearance. Information about the first feed after birth, time of initiation of breastfeeding, duration of exclusive breast feeding, time of introduction of complementary feeding, knowledge of feeding skills, mother’s concept of adequacy of breast milk were collected in the structured, pre tested proforma by personal one to one interview with the mothers. All the mothers of infants from 0 to 1 year were included. Statistical analysis: The data obtained by the interview were analyzed with regarding to mothers education level, religion and other related parameters pertaining to feeding practices. Percentages of parameters were calculated and analyzed. Results: Majority of the mothers belong to the age group of 18 to 30 years (96.01%), prelacteal feeds were given by a good number of mothers (42.32%), 60.66% mothers were given the sugar water as the prelacteal feed and 71.56% mothers have used cup and spoon to give prelacteal feeds. 75.25% of the mothers have practiced giving colostrum, 72.26% of mothers were breastfeeding their baby for 5 to 10 minutes during each feed at an interval of 0.5 hours to 3.5 hours. Majority of mothers (34.73%) had the knowledge of starting of weaning at six months and 46.88% of mothers were giving weaning food twice daily. Conclusion: Significant number of mothers had discarded colostrum and most of the mothers intended to give only breast milk upto four months and they did not have correct knowledge regarding exclusive breastfeeding upto six months.

Association of Child Feeding Practices with Nutritional Status of Under-two Slum Dwelling Children: A Community-based Study from West Bengal, India.

A cross-sectional study was conducted among 245 under-two slum-dwelling children in Bankura town, West Bengal, to assess their feeding practices and its association with nutritional status. Child’s gender, number of family members, standard of living (SLI), and household food security (HFS) were assessed through interview of mothers/ caregivers. Child feeding practices were measured with Composite Child Feeding Index comprising of age-appropriate, multiple, infant and young child feeding (IYCF) indicators and expressed in standardized IYCF score. Weight and length of the children were measured and the nutritional status was assessed using World Health Organization Growth Standard 2006. Standardized IYCF score was signifi cantly lower in undernourished children than those with normal grades. Per unit increase in standardized IYCF score was likely to reduce the prevalence of underweight, stunting and wasting by 2-3% after adjusting for other variables. Low/ very low HFS, low SLI and female gender were associated with underweight and stunting.

Overweight and Obesity among Malay Primary School Children in Kota Bharu, Kelantan: Parental Beliefs, Attitudes and Child Feeding Practices

Introduction: The increasing prevalence of overweight and obesity among children has become a major public health problem in Malaysia. Parents play an important role in child feeding especially among younger children. Methods: A study was conducted to evaluate the beliefs, attitudes and practices in child feeding among parents of normal weight, as well as overweight and obese primary school children in Kelantan using the Child Feeding Questionnaire (CFQ). This cross-sectional study was carried out on 175 Malay children from three schools in Kota Bharu district in Kelantan. Results: This study showed that 13.1% of the children were overweight and obese. Scores for perceived parent weight (p<0.05) and perceived child weight (p<0.001) were significantly higher among parents of overweight and obese children compared to parents of children with normal body weight. However, the score for pressure to eat among parents of overweight and obese children was significantly lower (p<0.05) than parents of normal weight children. The perceived child weight (r=0.468, p<0.01), perceived parental weight (r=0.190, p<0.05) and food restriction (r=0.179, p<0.05) factors were found to be positively correlated with children’s body mass index (BMI), whereas pressure to eat factor (r=-0.355, p<0.01) was negatively correlated with children’s body mass index (BMI). Conclusion: The findings showed that parental feeding practices were linked to children’s weight status and childhood obesity. Therefore parents should be given education and guidance on appropriate child feeding practices to maintain their child’s nutritional status on a healthy weight range.

Association between Infant- and Child-feeding Index and Nutritional Status: Results from a Cross-sectional Study among Children Attending an Urban Hospital in Bangladesh.

Integration of infant- and child-feeding index (ICFI) addressing the multidimensional child-feeding practices into one age-specific summary index is gaining importance. This cross-sectional study was aimed at understanding the association between the ICFI and the nutritional status of 259 children, aged 6-23 months, who attended the paediatric outpatient department of the Dhaka Medical College Hospital in Bangladesh. The mean length-for-age z-score (LAZ) of children aged 12-23 months was significantly (p<0.05) higher among those who were at the upper ICFI tercile compared to those who were at the middle or lower ICFI tercile (-2.01 and -3.20 respectively). A significant correlation was found between the ICFI and the LAZ (r=0.24, p=0.01 and r=0.29, p=0.01) in children aged 6-8-months and 12-23-months. Multivariable analysis, after adjusting for potential confounders, also found a significant association between the ICFI and the LAZ (β=0.13, p=0.03). The predictive capability of the proposed ICFI on nutritional status of children, especially length-for-age, needs to be further evaluated prospectively among healthy children in the community.

Familial and Socio-environmental Predictors of Overweight and Obesity among Primary Scholl Children in Selangor and Kuala Lumpur

Introduction: A cross-sectional study was conducted to determine the familial and socio-environmental predictors of overweight and obesity among 1430, 9- 12 year-old primary school children and their parents in Selangor and Kuala Lumpur. Methodology: Body weight and height were measured and body mass index was calculated. Modified Child Feeding (CFQ) and Determinants of Adolescent Social Well-being and Health (DASH) questionnaires were used to measure familial and socio-environmental factors. Results: A total of 17.9% of the children were overweight while 16.0% were obese. Positive relationships were found between child’s BMI and parent’s BMI (r = 0.129, p < 0.01), concern about child’s weight (r = 0.125, p < 0.01) and restriction (r = 0.057, p < 0.05) to unhealthy foods. However, negative relationships were found between child’s BMI with pressure to eat (r = -0.135, p < 0.01) and neighbourhood safety perception (r = -0.053, p < 0.05). The logistic regression analysis showed that being male (Exp (β) = 0.538; 95% CI = 0.421-0.687), higher parent’s BMI (Exp (β) = 1.055; 95% CI = 1.028-1.082), higher concern about child’s weight (Exp (β) = 1.082; 95% CI = 1.030- 1.127), low pressure to eat (Exp (β) = 0.857; 95% CI = 0.801-0.916) and low perception of neighbourhood safety (Exp (β) = 0.951; 95% CI = 0.913-0.990) were significantly associated with increased risk of overweight. Conclusion: Parents should be the main target for education to modify children’s weight status. Further research should be carried out to understand the mechanism of influence of parents and the socio-environment on child’s health.

Infant- and Young Child-feeding Practices in Bankura District, West Bengal, India.

A community-based, cross-sectional descriptive study was conducted during June-July 2008 to assess the infant- and young child-feeding (IYCF) practices in Bankura district, West Bengal, India. In total, 647 children aged less than two years selected through revised 40-cluster sampling using the indicators of the Integrated Management of Neonatal and Childhood Illness (IMNCI) and World Health Organization. The proportions of infants with early initiation of breastfeeding (13.6%) and exclusive breastfeeding under six months (57.1%) and infants who received complementary feeding at the age of 6-8 months (55.7%) were low. Appropriate feeding as per the IMNCI protocol was significantly less among infants aged 6-11 months (15.2%) and children aged 12-23 months (8.7%) compared to infants aged less than six months (57.1%), which could be attributable to low frequency and amount of complementary feeding. The main problems revealed from the study were late initiation of breastfeeding, low rates of exclusive breastfeeding, and inappropriate complementary feeding practices.