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      Mother, Infant, and Household Factors Associated with the Type of Food Infants Receive in Developing Countries

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          Abstract

          Objectives: We explore the complex factors associated with infant feeding by analyzing what mother, infant, and household factors are associated with the types of food given to infants. We seek to quantify associations in order to inform public health policy about the importance of target populations for infant feeding programs.

          Methods: We used data from the Demographic Health Survey in 20 developing countries for multiple years to examine mother, infant, and household factors associated with six types of food given to infants (exclusive breastfeeding, non-exclusive breastfeeding, infant formula, milk liquids, non-milk liquids, and solid foods). We performed a seemingly unrelated regressions analysis with community-year fixed effects to account for correlation between food types and control for confounding factors associated with community resources, culture, time period, and geography in the pooled analysis.

          Results: We found that several mother, infant, and household characteristics were associated with each of the feeding types. Most notably, mother’s education, working status, and weight are significantly associated with the type of food given to infants. We provide quantified estimates of the association of each of these variables with six types of food given to infants.

          Conclusion: By identifying maternal characteristics associated with infant feeding and quantifying those associations, we help public health policymakers generate priorities for targeting infant feeding programs to specific populations that are at greatest risk. Higher educated, working mothers are best to target with exclusive breastfeeding programs for young infants. Mothers with lower education are best to target with complementary feeding programs in infants older than 1 year. Finally, while maternal weight is associated with higher levels of exclusive breastfeeding the association is too weak to merit targeting of breastfeeding programs to low-weight mothers.

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          Child feeding practices are associated with child nutritional status in Latin America: innovative uses of the demographic and health surveys.

          Data from the Demographic and Health Surveys (DHS) for 5 Latin American countries (7 data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age Z-scores (HAZ). The variables used for the index were as follows: current breast-feeding, use of complementary foods and liquids in the past 24 h, frequency of use over the past week and feeding frequency. The index was made age specific for 6- to 9-, 9- to 12- and 12- to 36-mo-old age groups, and age-specific feeding terciles were created. Bivariate analyses showed that feeding practices were strongly and significantly associated with child HAZ in all 7 data sets, especially after 12 mo of age. Differences in HAZ between child feeding terciles remained significant after controlling for potentially confounding influences, for all countries except Bolivia. Multiple regression analyses also revealed that better feeding practices were more important for children of lower, compared with higher socioeconomic status (in Colombia 1995 and Nicaragua 1998); among children of Ladino (Spanish speaking) compared with indigenous origin (in Guatemala 1995); and among children whose mothers had primary schooling compared with mothers with no schooling, or mothers with higher than primary school level (Peru 1996). The data available in DHS data sets can thus be used effectively to create a composite child feeding index and to identify vulnerable groups that could be targeted by nutrition education and behavior change interventions.
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            Estimating a Household Production Function: Heterogeneity, the Demand for Health Inputs, and Their Effects on Birth Weight

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              Breast-feeding and feeding practices of infants in a developing country: a national survey in Lebanon.

              Breast-feeding (BF) provides the ideal food for the healthy growth and development of infants. The prevalence of BF in Lebanon shows mixed results. The present study was the first large-scale, extensive survey on BF parameters in Lebanon that aimed to explore demographic, socio-economic and other fundamental issues associated with the initiation and duration of BF by Lebanese mothers. The survey was cross-sectional in design and administered over 10 months. Information on all variables was collected from mothers at health centres. Two-stage sampling was conducted to select participants. A total of 1,000 participants were randomly selected. A consent form was provided to each participant. Data were collected from 830 of these. Almost all mothers were Lebanese, married and had given birth in a hospital. About a third stated that breast milk was the first food introduced after birth. Although 55.9% started breast-feeding their newborns within a few hours after birth, and 18.3% within half an hour, 21.2% replied that they initiated BF a few days after birth. Only 4.6% of the mothers replied that they never breast-fed their infant. Timing of initiation of BF was associated with the type of delivery (vaginal/Caesarean section) and hospital-related factors (rooming-in, night feedings and frequency of mother-infant interaction). Of the mothers who breast-fed exclusively beyond 6 months, 86.7% had initiated BF a few hours following delivery, while only 13.3% had initiated BF a few days later. Compared with the exceptionally high proportion of BF initiation, exclusivity of BF was low, dropping to 52.4% at 1 month. Exclusivity of BF was also associated with place of residence (urban/rural) and negatively associated with educational level of the mother. Duration of BF was inversely associated with the use of pain killers during delivery and maternal education. Rural mothers and those who practised exclusive BF maintained BF for a longer duration. Initiation rates of BF are very high in Lebanon but rates of exclusive BF are low and duration of BF is short. Future research targeting the factors associated with BF, with particular emphasis on exclusivity, is needed. For the 95.4% of mothers who initiated BF, an ecological perspective on intervention aimed at women and their social support system is required to improve duration and exclusivity.
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                Author and article information

                Contributors
                Journal
                Front Pediatr
                Front Pediatr
                Front. Pediatr.
                Frontiers in Pediatrics
                Frontiers Media S.A.
                2296-2360
                04 February 2014
                28 February 2014
                2014
                : 2
                : 14
                Affiliations
                [1] 1RTI International , Research Triangle Park, NC, USA
                [2] 2Nestlé Research Center , Lausanne, Switzerland
                Author notes

                Edited by: Frederick Robert Carrick, Carrick Institute, USA

                Reviewed by: Chulanee Thianthai, Chulalongkorn University, Thailand; Susan Elizabeth Esposito, Life University, USA; Linda Mullin Elkins, Life University, USA

                *Correspondence: Benjamin Yarnoff, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA e-mail: byarnoff@ 123456rti.org

                This article was submitted to Child Health and Human Development, a section of the journal Frontiers in Pediatrics.

                Article
                10.3389/fped.2014.00014
                3937551
                24616887
                3cf454dc-bffd-45c1-862e-d92c64456fcb
                Copyright © 2014 Yarnoff, Allaire and Detzel.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 January 2014
                : 13 February 2014
                Page count
                Figures: 0, Tables: 6, Equations: 0, References: 13, Pages: 10, Words: 6177
                Categories
                Pediatrics
                Original Research

                infant feeding practices,determinants of feeding,developing countries,nutrition,infant feeding policy

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