healthmedicinet

This study sought to quantify appropriate complementary feeding using a composite indicator comprising three of the WHO recommended core IYCF indicators. It also investigated factors that are associated with appropriate complementary feeding.

Due to the multidimensional nature of feeding practices, which is also age-specific [16], an appropriate tool to determine the overall child-feeding practices is yet to be determined. Minimum dietary diversity, adequacy of meal frequency and timely initiation of complementary feeding were the WHO indicators factors used in building the composite index and this study is the first of its kind in which important WHO IYCF indicators were combined to quantify appropriate complementary feeding in Northern Ghana. This composite index reflects key components of child feeding, namely appropriate timing of introduction of complementary foods, dietary density and adequacy of meal frequency.

The results revealed that the prevalence of appropriate complementary feeding was only 13.8 % which is similar to what was reported from Northern Ethiopia, Sri Lanka, Nepal and Tanzania Bangladesh, Zambia, and [17–20]. This indicates the general low level of appropriate complementary feeding practices in many countries including Ghana.

The three consistent variables that were found to be significantly associated with appropriate complementary feeding practice in this study were increasing child’s age, freedom from illness and whether the child was classified as positive, median or negative deviants. Other variables that were significant in bivariate analysis but failed to reach significance level in the multivariate analysis were region of residence, bottle feeding, religion of mother, timely initiation of breast feeding and absence of diarrhoeal infection.

Children within the age group 9–23 months were 14 times more likely to be appropriately fed as compared to infants in the age group 6–8 months. This finding is congruent with the findings in many countries including Ethiopia, Zambia Nepal, Indonesia and Tanzania where older children are more likely to be fed on complementary foods optimally [17, 20–22]. Education on complementary feeding should therefore target mothers of young children to give such children diversified diets that also meet adequate meal frequency. The 6–8 months age period is known to coincide with the period of the fastest growth faltering [23]. Poor complementary feeding practices in this age group should therefore be addressed effectively in order to greatly reduce the risk of growth faltering.

One would expect that positive deviant children will receive better appropriate feeding. Surprisingly, more of the negative deviant children (29.6 %) received appropriate complementary feeding compared to median growers (13.5 %) and positive deviants (13.2 %). The inverse relationship was more pronounced with respect to acceptable diet whereby 51.9 % of negative deviants, 26.6 % of median growers and 23.2 % met the criterion for acceptable diet. The issue of reverse causality may be applicable here whereby the sick child is given better care with regards to appropriate complementary feeding. This means, the undernutrition gives the mother the opportunity to provide appropriate complementary feeding.

Our data also showed that children with diarrhoeal infection were less likely to be fed appropriately. The negative association between sickness and appropriate complementary feeding is for the fact that some mothers would avoid feeding or reduce the meal frequency during diarrhoeal episode of the child and this will be detrimental to appropriate complementary feeding as defined in this study. Mothers should be educated and encouraged to continue to feed their children even when they have diarrhoea.

This study revealed that there was no association between frequency of antenatal care (ANC) visits and appropriate complementary feeding practice and same was reported in Northern Ethiopia [17] but that disagrees with other studies in Nepal, India and Sri Lanka [18, 19, 24] where inadequate antenatal care was associated with inappropriate complementary feeding. The finding in our study could imply that appropriate complementary feeding messages were either not being given to mothers by health professionals during antenatal or there was little variation in ANC attendance among the mothers. Most of the mothers (84.2 %) actually made at least four visits during the last pregnancy. Similarly, maternal educational level and socio-economic status as measured by household wealth index were also not associated with complementary feeding practices in this study. The lack of association may be attributed to the little variation of these variables in our study sample. In other studies, higher maternal education attainment is reported to associate positively with appropriate complementary feeding [19, 20]

Geographic location was also an important determinant of appropriate complementary feeding. Children from the Upper West and Upper East Regions were more likely to receive appropriate complementary feeding when compared to the children from Northern Region. The regional differentials in complementary feeding practices strongly suggest the importance of ensuring that interventions to improve complementary feeding are evidence-based and are informed by context specific formative research.

As expected, higher household wealth significantly increases diet diversity. Household wealth index positively associated with a higher dietary diversity score (DDS). Rich families are more likely to be able to afford and provide a variety of foods to their children more frequently. The positive association between higher household wealth and increased diet diversity has been consistently reported in earlier studies in different countries including Bangladesh, India, Nepal, Pakistan and Sri Lanka [25–27]. The fact that household wealth is a predictor of minimum dietary diversity underlines the important role of household resources in determining optimal complementary feeding practices.

Families that reported keeping chickens, ducks, or other birds for the meat/sale were more likely to provide children with diversified foods. Initial studies show a strong positive relationship between biodiversity in agricultural production and improved diversified diets [28]. Therefore, an appropriate mix of behaviour change communication and production of local food varieties and poultry resources could be a feasible option to increase recommended infant feeding practices and reduce under nutrition. Educational interventions can be implemented through existing mother’s group meetings, community health volunteers, and outreach clinics including primary health care outreach clinics will help promote good child feeding practices.