Menu
Menu
Menu
Menu
Background: Diarrhoea is a leading cause of child mortality in Tanzania. The association between optimal infant feeding practices and diarrhoea has been reported elsewhere, but the evidence has been limited to promote and advocate for strategic interventions in Tanzania. This study examined the association between infant and young child feeding (IYCF) practices and diarrhoea in Tanzanian children under 24 months. Methods: The study used the Tanzania Demographic and Health Survey data to estimate the prevalence of diarrhoea stratified by IYCF practices. Using multivariable logistic regression modelling that adjusted for confounding factors and cluster variability, the association between IYCF practices and diarrhoea among Tanzanian children was investigated. Results: Diarrhoea prevalence was lower in infants aged 0-5 months whose mothers engaged in exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) compared to those who were not exclusively and predominantly breastfed. Infants aged 6-8 months who were introduced to complementary foods had a higher prevalence of diarrhoea compared to those who received no complementary foods, that is, infants who were exclusively breastfed at 6-8 months. Infants who were exclusively and predominantly breastfed were less likely to experience diarrhoea compared to those who were not exclusively and predominantly breastfed [adjusted odds ratio (AOR) 0.31, 95% confidence interval (CI) 0.16-0.59, P < 0.001 for EBF and AOR = 0.30, 95% CI 0.10-0.89, P = 0.031 for PBF]. In contrast, infants aged 6-8 months who were introduced to complementary foods were more likely to experience diarrhoea compared to those who received no complementary foods (AOR = 2.91, 95% CI 1.99-4.27, P < 0.001). Conclusions: The study suggests that EBF and PBF were protective against diarrhoeal illness in Tanzanian children, while the introduction of complementary foods was associated with the onset of diarrhoea. Strengthening IYCF (facility- and community-based) programmes would help to improve feeding behaviours of Tanzanian women and reduce diarrhoea burden in children under 2 years.
The study used the Tanzania Demographic and Health Survey (TDHS, 2010) data, collected by the National Bureau of Statistics, Dar es Salaam, Tanzania, with technical assistance from the Inner City Fund (ICF) International, Maryland, USA. The TDHS collects maternal and child information that includes socio-demographics, child and female reproductive characteristics, obtained from a nationally representative sample of households. Using standardised face-to-face questionnaires, the TDHS collected information on IYCF practices from eligible women of childbearing age (15–49 years). For the IYCF practices, questions in the survey tool included information on breastfeeding and complementary feeding practices, as well as duration and diversity of the infant food provided. A weighted total sample of 10,139 eligible women were interviewed, yielding 96% response rate. Additional information on the data source (including sampling procedure and methodology for data collection) is described elsewhere [19, 30]. The study outcome was diarrhoea, defined as the passage of three or more loose or liquid stools per day, and was based on maternal recall of each child under 5 years of age in the household during the 2 weeks preceding the survey. Consistent with previous studies [18, 31], this analysis used information from the most recent live birth, aged less than 24 months, living with the respondent to reduce recall bias. Measurement of diarrhoea was based on the child age group for each IYCF practice [10]. The exposure variables for this study were the IYCF indicators, assessed based on the World Health Organization (WHO) definitions for assessing IYCF practices [32]: Early initiation of breastfeeding and EBF were incorporated into the analyses because of their association with reduced morbidity among children under 5 years [33, 34]. Predominant breastfeeding, bottle feeding, continued breastfeeding at 1 year and the introduction of solid, semi-solid and soft foods were included due to their effect on the increased risk of diarrhoeal morbidity and mortality among children under 5 years [10, 35–37]. A number of potential confounding variables were considered in the analyses based on previous studies [10, 24] and data availability. These variables were categorised as socioeconomic factors (mother’s employment, maternal education and household wealth), health service factor (frequency of antenatal care visit), individual factors (maternal age, child age and gender), and household factors (urban or rural, drinking water source and type of toilet facility). A detailed description of these variables is provided in Table 1. The household wealth index was calculated as a score of household assets (such as ownership of transportation devices, ownership of durable goods and household facilities), which was derived from a principal component analysis conducted by the National Bureau of Statistics, Dar es Salaam, Tanzania, and ICF International [19]. Characteristics of the study population N weighted sample size Source of drinking water was categorised as ‘Improved’ and ‘Not improved’. Improved drinking water source included residences where water was piped into the dwelling-yard, access to a public tap or standpipe, a tube well or borehole, protected well, protected spring, rainwater and/or bottled water. Not improved water source comprised access to an unprotected well, unprotected spring, tanker truck or cart with a drum, surface water, sachet water and/or another source [38]. Type of toilet was categorised as ‘Improved’ and Not improved’. Improved type of toilet included toilets such as flush or pour-flush toilets or piped to the sewer system, septic tank, and pit latrine; flush or pour-flush to septic tank; flush or pour flush to pit latrine; ventilated improved pit latrine; pit latrine with slab and/or compositing toilet. Not improved toilets comprised flush or pour-flush but not piped to sewer, septic tank or pit latrine; pit latrine without a slab or open pit; bucket or hanging toilet and no toilet facility or the use of bush or field [38]. The exposures were expressed as dichotomous variables, where respondents (women aged 15–49 years) who exclusively breastfed were coded as ‘1’ and those who did not were coded as ‘0’. The same analytical approach was employed for other IYCF indicators. Preliminary analyses involved frequency tabulations of confounding variables (i.e. socioeconomic, health service, individual and household factors) in the TDHS, followed by an estimation of the prevalence of IYCF indicators, as well as a combination of IYCF practices and diarrhoea (and their corresponding 95% confidence intervals). Univariable and multivariable logistic regression analyses were used to investigate the associations between IYCF practices and diarrhoea, adjusted for potential confounders. Regression models were restricted to the youngest living child aged < 24 months living with the respondent (women aged 15–49 years) to reduce recall bias. Prevalence estimates were calculated with the ‘svy’ function used to allow for adjustments for the cluster sampling design and regression modelling using the ‘xlogit’ function. All analyses were performed in Stata software version 14.0 (Stata Corporation, College Station, TX, USA). Measure DHS/ICF International obtained ethical approval from the Medical Research Coordinating Committee (MRCC), the national health research coordinating body in Tanzania. All questionnaires used for the DHS were reviewed and approved by ICF International Institutional Review Board (IRB) to ensure they met the US Department of Health and Human Services regulations for the protection of human participants as well as the host country’s IRB, to ensure compliance with national laws. The datasets used are available to apply for online, and approval was obtained from Measure DHS/ICF International for the analysis.
N/A
