Understanding delays in the introduction of complementary foods in rural Ethiopia.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101201025 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1740-8709 (Electronic) Linking ISSN: 17408695 NLM ISO Abbreviation: Matern Child Nutr Subsets: MEDLINE

Publication: Oxford, UK : Wiley-Blackwell
Original Publication: Oxford, UK : Blackwell Pub., c2005-

Infant Nutritional Physiological Phenomena* ; Health Knowledge, Attitudes, Practice* ; Rural Population*/statistics & numerical data; Humans ; Ethiopia ; Infant ; Female ; Adult ; Male ; Breast Feeding/statistics & numerical data ; Mothers/statistics & numerical data ; Young Adult ; Caregivers/statistics & numerical data ; Infant Food/statistics & numerical data

Age-appropriate breastfeeding and introduction to complementary foods can shape child feeding practices, ensure adequate energy and nutrient intake and prevent linear growth faltering. This study aimed to assess mothers' and health workers' knowledge of timely introduction to complementary foods and evaluate the relationship between delays in complementary feeding and subsequent linear growth. We conducted two rounds of surveys (March/August 2017) among 249 health workers (n = 249) and caregivers (n = 2635) of children 6-23 months of age. We collected information about socio-demographic characteristics, knowledge and practice related to timely introduction to complementary foods. The study was conducted in households from the Productive Safety Net Programme (PSNP) districts, in four highland regions of Ethiopia. Delays in the introduction to complementary feeding were widespread with 53% of children 6-8 months of age not consuming solid, semisolid or soft foods in the past 24 h. After controlling for child, caregiver and household characteristics, children not introduced to complementary foods by 6-8 months had a 0.48 SD lower length-for-age z-score at 12-15 months. Caregivers' knowledge was strongly and inversely correlated with untimely introduction of complementary foods in logistic regressions (OR = 0.55, p < 0.01). In turn, local health extension worker's knowledge was strongly correlated with caregiver's knowledge. Consequently, frequent and timely visits by health extension workers emphasising not only on what to feed but also when and how to feed a child are needed. Innovative ways of increasing reach, intensity and frequency of nutrition messaging by using the PSNP interactions as an additional point of contact would need to be explored further.
(© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Abadie, A., Athey, S., Imbens, G. W., & Wooldridge, J. (2017). When should you adjust standard errors for clustering? NBER Working Paper, (24003). National Bureau of Economic Research, Cambridge, MA.
Abate, G. T., Dereje, M., Hirvonen, K., & Minten, B. (2020). Geography of public service delivery in rural Ethiopia. World Development, 136, 105133. https://doi.org/10.1016/j.worlddev.2020.105133.
Abebe, Z., Haki, G. D., & Baye, K. (2016). Health extension workers' knowledge and knowledge‐sharing effectiveness of optimal infant and young child feeding are associated with mothers' knowledge and child stunting in rural Ethiopia. Food and Nutrition Bulletin, 37(3), 353–363. https://doi.org/10.1177/0379572116651209.
Allen, L. H., & Dror, D. K. (2018). Introduction to current knowledge on micronutrients in human milk: Adequacy, analysis, and need for research. Advances in Nutrition, 9(suppl_1), 275S–277S.
Baidal, J. A. W., Locks, L. M., Cheng, E. R., Blake‐Lamb, T. L., Perkins, M. E., & Taveras, E. M. (2016). Risk factors for childhood obesity in the first 1,000 days: A systematic review. American Journal of Preventive Medicine, 50(6), 761–779. https://doi.org/10.1016/j.amepre.2015.11.012.
Baye, K. (2019). Prioritizing the scale‐up of evidence‐based nutrition and health interventions to accelerate stunting reduction in Ethiopia. Nutrients, 11(12), 3065. https://doi.org/10.3390/nu11123065.
Baye, K. (2021). Improved diet quality, a missing ingredient for accelerating stunting reduction: An example from Ethiopia. Archives of Disease in Childhood, archdischild‐2020‐320292. https://doi.org/10.1136/archdischild-2020-320292.
Baye, K., & Faber, M. (2015). Windows of opportunity for setting the critical path for healthy growth. Public Health Nutrition, 18(10), 1715–1717. https://doi.org/10.1017/S136898001500186X.
Baye, K., & Hirvonen, K. (2020a). Accelerating progress in improving diets and nutrition in Ethiopia. IFPRI‐ESSP working paper, 144. Washington D.C.: Ethiopian Strategy Support Program (ESSP) and International Food Policy Research Institute (IFPRI).
Baye, K., & Hirvonen, K. (2020b). Seasonality: A missing link in preventing undernutrition. The Lancet Child & Adolescent Health, 4(1), PE3.
Baye, K., & Kennedy, G. (2020). Estimates of dietary quality in infants and young children (6–23 mo): Evidence from demographic and health surveys of 49 low‐and middle‐income countries. Nutrition, 78, 110875. https://doi.org/10.1016/j.nut.2020.110875.
Baye, K., Laillou, A., & Chitweke, S. (2020). Socio‐economic inequalities in child stunting reduction in Sub‐Saharan Africa. Nutrients, 12(1), 253. https://doi.org/10.3390/nu12010253.
Baye, K., Tariku, A., & Mouquet‐Rivier, C. (2018). Caregiver–infant's feeding behaviours are associated with energy intake of 9‐11 month‐old infants in rural Ethiopia. Maternal & Child Nutrition, 14(1), e12487. https://doi.org/10.1111/mcn.12487.
Berhane, G., Golan, J., Hirvonen, K., Hoddinott, J., Kim, S., Taffesse, A. S., Abay, K., Assefa, T., Habte, Y., Hiluf, M., Koru, B., Tadesse, F., Tesfaye, H., Wolle, A., & Yimer, F. (2020). Evaluation of the Nutrition‐sensitive Features of the Fourth Phase of Ethiopia's Productive Safety Net Programme. Addis Ababa: International Food Policy Research Institute (IFPRI), Ethiopia Strategy Support Program (ESSP).
Berhane, G., Hirvonen, K., & Hoddinott, J. (2016). The Implementation of the Productive Safety Nets Programme, 2014: Highlands Outcomes Report (2015). Addis Ababa: Ethiopia Strategy Support Program, International Food Policy Research Institute.
Berhane, G., Hoddinott, J., Kumar, N., & Margolies, A. (2015). The impact of Ethiopia's productive safety net programme on the nutritional status of children: 2008–2012. In IFPRI‐ESSP Working Paper, 99. Washington D.C.: International Food Policy Research Institute (IFPRI).
Bossuyt, A. (2017). Ethiopia productive safety net program, phase four: Detailed review of the progress on nutrition sensitive provisions (July 2015 to March 2017). In A Working Paper Presented to the PSNP Nutrition Task Force (April 2017). Addis Ababa: UNICEF.
Coulthard, H., Gillian, H., & Pauline, E. (2009). Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age. Maternal & child nutrition, 5(1), 75–85.
CSA. (2013). Population Projection of Ethiopia for All Regions at Wereda Level from 2014 – 2017. Addis Ababa, Ethiopia: Central Statistical Agency (CSA) of Ethiopia.
CSA, & ICF. (2016). Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: Central Statistical Agency (CSA) of Ethiopia and ICF.
Cusick, S. E., & Georgieff, M. K. (2016). The role of nutrition in brain development: The golden opportunity of the “first 1000 days”. The Journal of Pediatrics, 175, 16–21. https://doi.org/10.1016/j.jpeds.2016.05.013.
de Onis, M., Onyango, A. W., Borghi, E., Siyam, A., Nishida, C., & Siekmann, J. (2007). Development of a WHO growth reference for school‐aged children and adolescents. Bulletin of the World Health Organization, 85(9), 660–667. https://doi.org/10.2471/BLT.07.043497.
Dewey, K. G., & Brown, K. H. (2003). Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs. Food and Nutrition Bulletin, 24(1), 5–28. https://doi.org/10.1177/156482650302400102.
Dhami, M. V., Ogbo, F. A., Osuagwu, U. L., Ugboma, Z., & Agho, K. E. (2019). Stunting and severe stunting among infants in India: The role of delayed introduction of complementary foods and community and household factors. Global Health Action, 12(1), 1638020. https://doi.org/10.1080/16549716.2019.1638020.
Frongillo, E. A. (2020). Designing and implementing at‐scale programs to improve complementary feeding. Nutrition Reviews, 78(Supplement_2), 62–70.
GFDRE. (2014). Productive Safety Net Programme 4: Design Document. Addis Ababa: Government of the Federal Democratic Republic of Ethiopia (GFDRE).
Golan, J., Headey, D., Hirvonen, K., & Hoddinott, J. (2019). Changes in child undernutrition rates in Ethiopia, 2000‐16. In C. Cramer, F. Cheru, & A. Oqubay (Eds.), The Oxford Handbook of the Ethiopian Economy. Oxford: Oxford University Press.
Kramer, M. S., Chalmers, B., Hodnett, E. D., Sevkovskaya, Z., Dzikovich, I., Shapiro, S., Collet, J.‐P., Vanilovich, I., Mezen, I., Ducruet, T., Shishko, G., Zubovich, V., Mknuik, D., Gluchanina, E., Dombrovskiy, V., Ustinovitch, A., Kot, T., Bogdanovich, N., Ovchinikova, L., … for the PROBIT Study Group. (2001). Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA, 285(4), 413–420. https://doi.org/10.1001/jama.285.4.413.
Lemma, F., & Matji, J. (2013). Delivery platforms for sustained nutrition in Ethiopia. The Lancet, 382(9891), 488–489. https://doi.org/10.1016/S0140-6736(13)61054-5.
Lutter, C. K., Grummer‐Strawn, L., & Rogers, L. (2021). Complementary feeding of infants and young children 6 to 23 months of age. Nutrition Reviews. https://doi.org/10.1093/nutrit/nuaa143.
Mangham‐Jefferies, L., Mathewos, B., Russell, J., & Bekele, A. (2014). How do health extension workers in Ethiopia allocate their time? Human Resources for Health, 12(1), 1–12. https://doi.org/10.1186/1478-4491-12-61.
Martorell, R. (2017). Improved nutrition in the first 1000 days and adult human capital and health. American Journal of Human Biology, 29(2), e22952. https://doi.org/10.1002/ajhb.22952.
Mbuya, M. N., Menon, P., Habicht, J.‐P., Pelto, G. H., & Ruel, M. T. (2013). Maternal knowledge after nutrition behavior change communication is conditional on both health workers' knowledge and knowledge‐sharing efficacy in rural Haiti. The Journal of Nutrition, 143(12), 2022–2028. https://doi.org/10.3945/jn.113.178442.
Menon, P., Ruel, M. T., Nguyen, P. H., Kim, S. S., Lapping, K., Frongillo, E. A., & Alayon, S. (2020). Lessons from using cluster‐randomized evaluations to build evidence on large‐scale nutrition behavior change interventions. World Development, 127, 104816. https://doi.org/10.1016/j.worlddev.2019.104816.
PAHO/WHO. (2003). Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, D.C.: Pan American Health Organization (PAHO) and World Health Organization (WHO).
UNICEF, MOLSA, & IFPRI. (2020). Impact Evaluation of Improved Nutrition through Integrated Basic Social Services and Social Cash Transfer Pilot Program (IN‐SCT) in Oromia and SNNP Regions. Ethiopia: End‐line Impact Evaluation Report. Washington D.C.
UNICEF, WHO, & World Bank Group. (2020). Levels and Trends in Child Malnutrition: Key Findings of the 2020 Edition. Geneva: UNICEF, WHO and World Bank Group.
Victora, C. G., Christian, P., Vidaletti, L. P., Gatica‐Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low‐income and middle‐income countries: Variable progress towards an unfinished agenda. The Lancet, 397, 1388–1399. https://doi.org/10.1016/S0140-6736(21)00394-9.
Victora, C. G., de Onis, M., Hallal, P. C., Blossner, M., & Shrimpton, R. (2010). Worldwide timing of growth faltering: Revisiting implications for interventions. Pediatrics, 125(3), e473–e480. https://doi.org/10.1542/peds.2009-1519.
WHO. (2006). WHO child growth standards based on length/height, weight and age. Acta Paediatrica, 450, 76–85.
WHO. (2008). Indicators for Assessing Infant and Young Child Feeding Practices: Part 1: Definitions: Conclusions of a Consensus Meeting Held 6–8 November 2007 in Washington DC, USA. Geneva: World Health Organization (WHO).
WHO. (2013). Essential Nutrition Actions: Improving Maternal, Newborn, Infant and Young Child Health and Nutrition (9241505559). Geneva: World Health Organization (WHO).
WHO, & UNICEF. (2009). WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children's fund. Geneva: World Health Organization & UNICEF.
WHO, & UNICEF. (2021). Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods. Geneva: World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).
Workie, N. W., & Ramana, G. (2013). The Health Extension Program in Ethiopia. UNICO Studies Series, No. 10. Washington, D.C: The World Bank.
World Bank. (2018). The State of Social Safety Nets 2018. Washington D.C: World Bank.

UNICEF; Bill and Melinda Gates Foundation; UNICEF Ethiopia

Keywords: breastfeeding; child feeding; complementary foods; linear growth; stunting

Date Created: 20210915 Date Completed: 20240720 Latest Revision: 20240721

20240721

PMC11258766

10.1111/mcn.13247

34523796