improving diet quality among infants and young children
DESCRIPTION
Improving Diet Quality Among Infants and Young Children: Challenges and Potential Solutions, by Dr. Purnima Menon, IFPRITRANSCRIPT
Improving Diet Quality Among Infants and Young Children: Challenges and
Potential Solutions
Purnima Menon International Food Policy Research Institute
Workshop on
The Feed the Future Zone in the South and the Rest of Bangladesh:
A Comparison of Food Security Aspects 16 January 2013
Dhaka 1
Why care about diet quality?
• Diet quality (as measured by proxy indicators such a diversity) is associated with better nutritional outcomes for children
• Diet quality for young children, especially diversity, is known to be a problem in most developing countries
2 Zongrone et al., Public Health Nutrition, 2012
IYCF practices in the FTF zone compared to the rest of the country
3 0 20 40 60 80 100 120
Exclusive breastfeeding under 6 months
Continued breastfeeding at 1 year
Introduction of solid, semi-solid or soft foods
Minimum dietary diversity (4+ food groups)
Minimum meal frequency
Minimum acceptable diet
Consumption of iron-rich or iron-fortified foods
BDHS
BIHS
FTF
Timely introduction of high nutrient-value foods is low (BIHS sample)
Before 6 mo
6-8.9 mo After 9 mo
Complementary food % % %
Water 69.8 29.0 1.2 Other non-breast milk liquids (e.g. sugar/glucose water, tea, fruit juice, etc.)
48.3 49.0 2.8
Cow or goat milk 37.4 49.9 12.7
Sooji, rice gruel, etc. 27.9 65.9 6.3 Semi-solid foods (e.g. soft rice, mashed potato, ripe banana, etc.)
12.5 76.9 10.7
Solid foods (e.g. rice, wheat, puffed or pressed rice, etc.) 7.5 67.5 25.0
Fish 5.9 65.3 28.7
Meat 5.0 60.8 34.2 Eggs 7.2 71.9 20.9
Legumes 6.3 72.5 21.2 Green vegetables 6.0 75.0 19.0 Snack foods (e.g. chips) 3.3 54.2 42.5 4
Diet diversity is especially low for 6-8 mo old infants (BIHS sample; 24-hr food group recall)
Items fed to children aged 6-8 months based upon 24 hour recall % (N = 115)
Liquids
Breast milk 98.2
Water 87.5
Prepared baby formula 16.1
Any other kind of milk (e.g. powder, cow, goat, etc.) 31.8
Fruit juice (homemade) 8.0 Fruit juice (purchased) 1.2
Water-based liquids (e.g. teas, sugar water, coffee, etc.) 42.6
Food groups Grains, roots, and tubers 70.3
Legumes and nuts 8.3 Dairy (e.g. milk, yogurt, cheese) 42.9
Flesh foods (e.g. meat, fish, poultry, and liver/organ meats) 5.3
Eggs 8.3
Vitamin A-rich fruits and vegetables 16.2 Other fruits and vegetables 10.4 5
Types of food fed to children is not different by gender for children 6-23 months old (BIHS sample)
6
0
20
40
60
80
Gra
ins,
ro
ots
,an
d t
ub
ers
Legu
mes
an
dn
uts
Dai
ry (
e.g.
milk
,yo
gurt
, ch
eese
)
Fles
h f
oo
ds
(e.g
. mea
t, f
ish
,p
ou
ltry
, an
d…
Eggs
Vit
amin
A-r
ich
fru
its
and
vege
tab
les
Oth
er f
ruit
s an
dve
geta
ble
s
Pe
rce
nta
ge
Boys Girls TOTAL
% of children 6-23 months old achieving minimum diet diversity, by division and wealth
7
0
10
20
30
40
50
60
70
80
90
100
Division Wealth group %
Use of micronutrient supplements (BIHS)
8
Mother tookiron
tablets/supplements during
recentpregnancy
Mother wasgiven vitamin A
capsule afterdelivery
For childrenaged 6-23
months, childreceived acapsule of
vitamin A in last6 months
Diarrhea: oralrehydration
solution (ORS)that was
purchased.
Diarrhea: zinctablets.
Series1 56.0 23.6 70.7 86.7 21.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
%
Maternal nutrition knowledge is variable (BIHS)
9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Baby should bebreastfed
immediately or <1hour after birth
Baby should bebreastfed colostrum
after birth
Iron deficiency canimpair child growthand development
Handwashing beforefeeding a child.
%
Awareness about micronutrient powders (BIHS) is especially low
10
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1 (lowest) 2 3 4 5 (highest)
Percentage of mothers under-twos who have heard about MNPs, by SES (BIHS)
What are some solutions?
• Improving diet quality requires investments in: – Behavior change communication
– Shaping social norms
– Addressing food insecurity (often a predictor of diet quality for young children)
• A challenge is implementing interventions to address this issue at scale!
• IFPRI’s evaluation of Alive & Thrive interventions implemented by BRAC and FHI360 are shedding light on this
12
INSIGHTS FROM ALIVE & THRIVE EVALUATION RESEARCH BY IFPRI ON
POTENTIAL SOLUTIONS TO IMPROVING IYCF AND DIET QUALITY
13
A&T evaluation design
14
60 Rural upazilas (50 + 10)
20 (paired) rural EHC upazilas
10 upazilas A&T Intensive
10 upazilas A&T Non-intensive
Baseline Survey (April-July 2010)
A&T Endline Survey (April-July 2014)
Process Evaluation Survey (June-July 2012)
A&T HH Survey(April-July 2013)
FHW Survey (September-October 2011)
Process evaluation
Both
qualitative and
quantitative
Early impacts of Alive & Thrive’s interventions on infant
and young child feeding practices (WHO indicators)
0 10 20 30 40 50 60 70 80 90 100
Early initiation
EBF 0-5.9 mo
Continued BF 12-15 mo
Solid/semi-solids in 6-8.9 mo
Min diet diversity 6-23 mo
Min meal freq (6-23 mo)
Min acceptable diet (6-23 mo)
Iron food (6-23 mo)
A&T (2012) Non-A&T (2012) Baseline (2010)
*
***
**
* p < 0.05, ** p < 0.01, *** p < 0.001
%
Non-A&T= Non-intensive 15
More households in A&T areas have heard complementary feeding and MNP messages
0
20
40
60
80
100
Feed mashed familyfood to children aged >
6 months
Feeding animal sourcefoods to children aged
> 6 months
Cook children's foodwith oil
Add Multiple NutrientPowder (MNP) to the
child's food
Per
cen
t
Baseline (2010) A&T Intensive (2012) A&T Non-Intensive (2012)
These 2 behaviors – use of oil and MNPs - are mainly promoted by FHWs, not the media campaign
Health worker visits to HH is high in A&T areas
0
10
20
30
40
50
60
70
80
90
100
Ever had HHvisit by SS/PS
(unaidedrecall)
Ever had HHvisit by SS/PS(aided recall)
A&T Area
Non-A&T Area
SS/PS
0
10
20
30
40
50
60
70
80
90
100
Ever had HH visitby SK (unaided
recall)
Ever had HH visitby SK (aided
recall)
A&T Area
Non-A&T Area
SK
0
10
20
30
40
50
60
70
80
90
100
Ever had HHvisit by PK(unaided
recall)
Ever had HHvisit by PK
(aided recall)
A&T Area
PK
Non-A&T= Non-intensive
Mass media campaign: recall of TVCs among total sample in A&T evaluation sample
0
10
20
30
40
50
60
A&T Intensive Areas A&T Non-IntensiveAreas
Perc
ent
Early initiation of breastfeeding
Exclusive breast feeding
Animal source food after 6months
Poor appetite
Frequency ofcomplementary feeding
The house is on fire
18
INSIGHTS FROM THE BANGLADESH INTEGRATED HOUSEHOLD SURVEY ON
ACCESS TO KEY INTERVENTION PLATFORMS
19
Exposure to counseling by health workers is quite low
TOTAL (n=979)
Literate mother
(N = 886)
Illiterate mother (N = 93)
% % %
Have been visited at home by any health worker in the last 6 months
25.8 26.5 19.2
Visited by a health worker ≥3 times in the last 6 months (among those visited in the last 6 mo)
43.6 43.5 45.5
Received advice from health worker about feeding the child during last visit (among those visited in the last 6 mo)
59.2 59.7 52.6
20
Exposure and recall of national IYCF communications campaign (BIHS, all female respondents, N=5503)
21
27.8
22.8
14.3
24.5
17.3 17.7
22.7 20.7
11.4
21.8
15.3 16.2
Advertisementabout a
newborn baby("A mother of
a newbornbaby")
Advertisementabout
breastfeeding("Father bringstinned milk for
baby")
Advertisementabout a houseon fire ("House
is on fire")
Advertisementabout cookingfish ("Mothercooking fish")
Advertisementabout sports
("Tumpa winsa prize")
Advertisementabout child
feeding ("Babygoes to sleep
withouteating")
Pe
rce
nta
ge
Recalled seeing this television advertisement
Correctly recalled any of the message(s)
Summary
• FTF and BIHS data affirm the significant challenge of ensuring nutritionally adequate infant and young child diets
• Poor feeding practices and low use of micronutrient supplements poor nutrient quality of diets, overall
• Early results from evaluation research suggest interventions such as those implemented by Alive & Thrive have potential to improve diet quality through high quality, high coverage interventions
• A significant challenge, seen in the BIHS, is that overall access to interventions (mass media and health worker counseling) that can improve IYCF is currently lower than desirable
22
Next steps
• Further disaggregated descriptive analysis, not just by age, gender and SES, but also other maternal and household characteristics
• Empirical analyses and research papers on: – Predictors of anthropometric outcomes and IYCF
practices
– Links between agriculture and nutritional outcomes
– Other
23