Risk factors of poor complementary feeding practices in Pakistani children aged 6-23 months: A multilevel analysis of the Demographic and Health Survey 2012-2013

Abstract

Appropriate feeding practices are crucial for survival, growth, and development in childhood. This paper analyzes Pakistan's Demographic and Health Survey 2012-2013 to fill the knowledge gap in risk factors of poor complementary feeding practices in Pakistani children. Multilevel models were applied to fit the multistage cluster sample of 2,827 children aged 6-23 months from 489 communities. Introduction of solid, semi-solid, or soft foods (intro) was achieved in 67% infants aged 6-8 months. Among children aged 6-23 months, the proportion of children meeting minimum meal frequency, dietary diversity (MDD), and acceptable diet criteria were 63%, 22% and 15%, respectively. Consumption of legumes and nuts, flesh foods, and vitamin A-rich fruits and vegetables was low in all children (6-19%), even among children who met the MDD criteria (15-55%). Younger child age, especially between 6 and 11 months and delayed maternal postnatal checkup were significant individual-level risk factors that consistently increased the odds of not meeting all four criteria examined. Fewer antenatal care visits predicted the odds of achieving intro and minimum meal frequency while younger maternal age and household poverty predicted the odds of achieving MDD and minimum acceptable diet. Community-level factors included geographic region and general access to maternal and child health care services. The overall poor quality of children's complementary diets in Pakistani calls for stronger policy and program action to promote the consumption of key nutrient-dense foods while prioritizing interventions for the most vulnerable children and populations.

Keywords: Pakistan; complementary foods and feeding; demographic and health survey; dietary diversity; multilevel model; risk factors.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2017 John Wiley & Sons Ltd.

Figures

Figure 1

Distribution of complementary feeding practices among children aged 6–23 months by age group and feeding status. Error bars are the lower and upper 95% confidence bounds of the proportion. BF = breastfed; non‐BF = nonbreastfed; intro = introduction of solid, semi‐solid, and soft food; MMF = minimum meal frequency; MDD = minimum dietary diversity; MAD = minimum acceptable diet

Figure 2

Patterns of food group consumption by child age group. (a) Proportion of children consuming different number of food groups and (b) proportion of food group consumption by child age. The orange vertical line indicates the minimum required four food groups per WHO's recommendation. Error bars are the lower and upper 95% confidence bounds of the proportion. DDS = dietary diversity score

Figure 3

Proportion of food group consumption by child age among children with minimum dietary diversity (dietary diversity score [DDS] = 4, 5, or 6. Children with DDS = 7 was excluded because there is no variation). Error bars are the lower and upper 95% confidence bounds of the proportion