How well do WHO complementary feeding indicators relate to nutritional status of children aged 6–23 months in rural Northern GhanaReport as inadecuate

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BMC Public Health

, 15:1157

First Online: 23 November 2015Received: 21 February 2015Accepted: 17 November 2015DOI: 10.1186-s12889-015-2494-7

Cite this article as: Saaka, M., Wemakor, A., Abizari, AR. et al. BMC Public Health 2015 15: 1157. doi:10.1186-s12889-015-2494-7


BackgroundThough the World Health Organization WHO recommended Infant and Young Child Feeding IYCF indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet and child growth indicators.

MethodsA community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers-primary caregivers and their children selected using a two-stage cluster sampling procedure.

ResultsOf the 1984 children aged 6–23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity ≥4 food groups, 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively.

Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition AOR = 0.75, CI = 0.50 - 0.95, P = 0.02. It was found that children whose mothers attended antenatal care ANC at least 4 times were 34 % protected AOR 0.66; 95 % CI 0.50 - 0.88 against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected AOR 0.49; 95 % CI 0.26 - 0.94 against chronic malnutrition compared to children from households with low household wealth index.

After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ β = 0.10, p = 0.005 but was not associated with mean LAZ.

ConclusionsThe WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators.

KeywordsChild Nutritional status Appropriate complementary feeding IYCF indicators Composite indicator Northern Ghana AbbreviationsANOVAAnalysis of variance

ANCAntenatal care

AORAdjusted odds ratio

CFIChild feeding index

CIConfidence interval

DDSDietary diversity score

DHSDemographic and health surveys

ENAThe Emergency Nutrition Assessment

GAMGlobal acute malnutrition

IYCFInfant and young child feeding

LAZLength -for-age Z-score

MADMinimum acceptable diet

MDDMinimum dietary diversity

MMFMinimum meal frequency

MUACMid-upper arm circumference

PCAPrincipal Component Analysis

PPSProbability proportionate to size

SMARTStandardized Monitoring and Assessment of Relief and Transitions

WAZWeight-for-age Z-score

WLZWeight-for-length Z-score

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12889-015-2494-7 contains supplementary material, which is available to authorized users.

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Author: Mahama Saaka - Anthony Wemakor - Abdul-Razak Abizari - Paul Aryee


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