Infant and young child feeding practices among adolescent mothers and associated factors in India

Nutrients, Volume 13, No. 7, Year 2021

Interpretation

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India. This study utilized data extracted from the 2015–2016 India National Family Health Survey (NFHS-4); also referred to as the 2015–16 India Demographic and Health Survey (DHS), conducted by the International Institute for Population Sciences, Mumbai, India. Details of the methodology and sampling procedure of the survey can be found elsewhere [23]. Sociodemographic, household characteristics, and data on infant and young child feeding practices were collected from a sample of respondents (adolescent mothers aged between 15 and 19 years). A multistage cluster sampling design was used for the survey (which adopted a standardized questionnaire), from NFHS-4. The study was limited to children who were alive, of singleton births, last-born, aged 0–23 months and lived with the respondent. The survey yielded a weighted total of 5148 children with an average response rate of 94%. The study outcomes were the 2008 IYCF (BF and CF) indicators prescribed by the World Health Organization (WHO) [24]. The study was based on the recall of mothers regarding the food they fed their child within the 24 h preceding the survey. In this study, we considered four key BF indicators because exclusive breastfeeding and early initiation of breastfeeding are protective factors for child mortality and morbidity, while predominant breastfeeding and bottle feeding increases the risk of diarrhea and respiratory illness [25]. The selected BF indicators for our study are defined below: The CF indicators considered in the study are defined below: The independent variables were composed of socio-demographic and economic characteristics of children and their parents. The choice to use these variables was informed by previous literature [26,27,28,29] and their availability in the India 2015–2016 NFHS dataset. They were classified into three levels: individual-, household- and community-level factors. Individual-level factors consisted of characteristics of the mother (religion, age, work status, education, literacy, body mass index (BMI), age, marital status, place and mode of delivery, delivery assistance, number of antenatal visits, postnatal checks, access to the media, and power over earning and decision making), the father (occupation) and the child (sex, age, birth weight, birth order, birth interval, illness, and perceived size at birth). The wealth index, number of living children, quality of the source of drinking water, and quality of the type of toilet facility constituted the household-level factors, while the community-level factors were composed of the type of residence, geographic region, and type of caste or tribe. In the NFHS, the principal components analysis [30] was used to construct the household wealth index. The latter was calculated as a score of ownership of household assets, such as transportation device, ownership of durable goods, and household facilities. Furthermore, the index was divided into three categories, namely, poor, middle, and rich (detailed information on the definition and categorization of potential confounding variables used in the study is provided in Supplementary Table S1). The strategy for the analyses in this study was in line with that of previously published research [31,32,33]. Preliminary analyses involved the assessment of frequencies and cross-tabulations to estimate the prevalence of all the IYCF indicators used in the study. An estimation of the prevalence and corresponding confidence intervals of IYCF indicators then followed. IYCF indicators used in the study were categorized as binary (yes as ‘1′ and no as ‘0′) and we then conducted univariable and multivariable survey logistic regression analyses to examine the association between the study variables (individual-, household- and community-level factors) adjusted for clustering and sampling weights. Survey logistic regressions that adjusted for cluster and survey weights were used to identify unadjusted odds ratios of all the study outcomes. A three-staged modelling technique was adopted for the survey multivariable analyses in which level factors were entered progressively into the model to assess associations with the study outcomes. In the first stage, individual-level factors were entered into the baseline multivariable model to examine their association with the study outcomes. Thereafter, a manually executed elimination method was used to determine factors associated with IYCF at a 0.05 significance level (Model 1). In the second stage, household-level factors were added to Model 1, and those factors with p-values < 0.05 were retained (Model 2) after a manually executed elimination method was conducted. In the third stage, community-level factors were added to Model 2. As before, those factors with p-values < 0.05 were retained (Model 3). Only those factors significantly associated with IYCF at a 5% significance level in Model 3 were reported in the study. In the final model, we tested and reported any co-linearity. We then calculated the odds ratios with 95% confidence intervals derived from the adjusted logistic regression models, which were used to determine the level of association of the factors of possible confounding variables, and all analyses were conducted using Stata version 14.0 (Stata Corp, College Station, TX, USA).

AI Digest

Study Justification:

– Adequate infant and young child feeding (IYCF) practices are crucial for child survival and growth.
– Adolescent mothers in India have insufficient knowledge of child growth, leading to adverse birth outcomes.
– This study aims to examine the factors associated with IYCF practices among adolescent Indian mothers.

Study Highlights:

– The study utilized data from the 2015-2016 India National Family Health Survey.
– Prevalence rates for various IYCF indicators were assessed, including exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates.
– Factors associated with breastfeeding practices included maternal education, mode of delivery, frequency of antenatal care clinic visits, geographical region, child’s age, and household wealth.
– Factors associated with complementary feeding practices included maternal education, maternal marital status, child’s age, frequency of antenatal care clinic visits, geographical region, and household wealth.
– The study highlights the suboptimal IYCF practices among adolescent mothers in India, except for breastfeeding.
– Health and nutritional support interventions should address the identified factors to improve IYCF practices among adolescent mothers in India.

Recommendations:

– Implement targeted interventions to improve knowledge and practices related to infant and young child feeding among adolescent mothers.
– Enhance access to quality antenatal care services and promote regular clinic visits among adolescent mothers.
– Develop educational programs to improve maternal education and literacy, particularly among adolescent mothers.
– Address regional disparities in IYCF practices by implementing region-specific interventions.
– Strengthen efforts to improve household wealth and economic conditions to support optimal IYCF practices.

Key Role Players:

– Ministry of Health and Family Welfare, Government of India
– International Institute for Population Sciences, Mumbai, India
– Non-governmental organizations (NGOs) working in the field of maternal and child health
– Health professionals, including doctors, nurses, and nutritionists
– Community health workers and volunteers
– Educators and school administrators
– Media organizations for disseminating information and awareness campaigns

Cost Items for Planning Recommendations:

– Development and implementation of educational programs and materials
– Training and capacity building for health professionals and community workers
– Outreach and awareness campaigns targeting adolescent mothers and their families
– Provision of nutritional supplements and support for breastfeeding and complementary feeding
– Monitoring and evaluation activities to assess the impact of interventions
– Research and data collection to track progress and identify areas for improvement

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it is based on a cross-sectional study utilizing data from a nationally representative survey. The study utilized a large sample size and employed survey logistic regression to assess factors associated with infant and young child feeding practices among adolescent mothers in India. However, the study is limited to recall data from mothers regarding the food they fed their child within the 24 hours preceding the survey, which may introduce recall bias. Additionally, while the study adjusted for clustering and sampling weights, it is important to note that the study design is cross-sectional, which limits the ability to establish causality. To improve the evidence, future research could consider longitudinal designs to better understand the temporal relationships between factors and infant and young child feeding practices among adolescent mothers.

Abstract

This study utilized data extracted from the 2015–2016 India National Family Health Survey (NFHS-4); also referred to as the 2015–16 India Demographic and Health Survey (DHS), conducted by the International Institute for Population Sciences, Mumbai, India. Details of the methodology and sampling procedure of the survey can be found elsewhere [23]. Sociodemographic, household characteristics, and data on infant and young child feeding practices were collected from a sample of respondents (adolescent mothers aged between 15 and 19 years). A multistage cluster sampling design was used for the survey (which adopted a standardized questionnaire), from NFHS-4. The study was limited to children who were alive, of singleton births, last-born, aged 0–23 months and lived with the respondent. The survey yielded a weighted total of 5148 children with an average response rate of 94%. The study outcomes were the 2008 IYCF (BF and CF) indicators prescribed by the World Health Organization (WHO) [24]. The study was based on the recall of mothers regarding the food they fed their child within the 24 h preceding the survey. In this study, we considered four key BF indicators because exclusive breastfeeding and early initiation of breastfeeding are protective factors for child mortality and morbidity, while predominant breastfeeding and bottle feeding increases the risk of diarrhea and respiratory illness [25]. The selected BF indicators for our study are defined below: The CF indicators considered in the study are defined below: The independent variables were composed of socio-demographic and economic characteristics of children and their parents. The choice to use these variables was informed by previous literature [26,27,28,29] and their availability in the India 2015–2016 NFHS dataset. They were classified into three levels: individual-, household- and community-level factors. Individual-level factors consisted of characteristics of the mother (religion, age, work status, education, literacy, body mass index (BMI), age, marital status, place and mode of delivery, delivery assistance, number of antenatal visits, postnatal checks, access to the media, and power over earning and decision making), the father (occupation) and the child (sex, age, birth weight, birth order, birth interval, illness, and perceived size at birth). The wealth index, number of living children, quality of the source of drinking water, and quality of the type of toilet facility constituted the household-level factors, while the community-level factors were composed of the type of residence, geographic region, and type of caste or tribe. In the NFHS, the principal components analysis [30] was used to construct the household wealth index. The latter was calculated as a score of ownership of household assets, such as transportation device, ownership of durable goods, and household facilities. Furthermore, the index was divided into three categories, namely, poor, middle, and rich (detailed information on the definition and categorization of potential confounding variables used in the study is provided in Supplementary Table S1). The strategy for the analyses in this study was in line with that of previously published research [31,32,33]. Preliminary analyses involved the assessment of frequencies and cross-tabulations to estimate the prevalence of all the IYCF indicators used in the study. An estimation of the prevalence and corresponding confidence intervals of IYCF indicators then followed. IYCF indicators used in the study were categorized as binary (yes as ‘1′ and no as ‘0′) and we then conducted univariable and multivariable survey logistic regression analyses to examine the association between the study variables (individual-, household- and community-level factors) adjusted for clustering and sampling weights. Survey logistic regressions that adjusted for cluster and survey weights were used to identify unadjusted odds ratios of all the study outcomes. A three-staged modelling technique was adopted for the survey multivariable analyses in which level factors were entered progressively into the model to assess associations with the study outcomes. In the first stage, individual-level factors were entered into the baseline multivariable model to examine their association with the study outcomes. Thereafter, a manually executed elimination method was used to determine factors associated with IYCF at a 0.05 significance level (Model 1). In the second stage, household-level factors were added to Model 1, and those factors with p-values < 0.05 were retained (Model 2) after a manually executed elimination method was conducted. In the third stage, community-level factors were added to Model 2. As before, those factors with p-values < 0.05 were retained (Model 3). Only those factors significantly associated with IYCF at a 5% significance level in Model 3 were reported in the study. In the final model, we tested and reported any co-linearity. We then calculated the odds ratios with 95% confidence intervals derived from the adjusted logistic regression models, which were used to determine the level of association of the factors of possible confounding variables, and all analyses were conducted using Stata version 14.0 (Stata Corp, College Station, TX, USA).

Materials

https://efashare.b-cdn.net/materials/b4ce5d886eb07b572f1badd6ae045d3e42979117c615f66c7259784970699781/nutrients-13-02376-s001.zip

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide adolescent mothers with information and reminders about infant and young child feeding practices. These apps can also connect them with healthcare professionals for guidance and support.

2. Community-Based Support Groups: Establish community-based support groups specifically for adolescent mothers, where they can receive education, counseling, and peer support on infant and young child feeding practices. These groups can be facilitated by trained healthcare workers or community volunteers.

3. Targeted Health Education Programs: Design targeted health education programs that focus on improving knowledge and awareness of infant and young child feeding practices among adolescent mothers. These programs can be delivered through schools, community centers, and healthcare facilities.

4. Integrated Maternal and Child Health Services: Integrate maternal and child health services to ensure that adolescent mothers receive comprehensive care that includes education, counseling, and support for infant and young child feeding practices. This can be achieved by coordinating efforts between healthcare providers, schools, and community organizations.

5. Financial Incentives: Implement financial incentives for adolescent mothers who adhere to recommended infant and young child feeding practices. This can help motivate and encourage them to prioritize their child’s nutrition.

6. Telemedicine Services: Utilize telemedicine services to provide remote consultations and support for adolescent mothers regarding infant and young child feeding practices. This can be especially beneficial for those who have limited access to healthcare facilities.

7. Training and Capacity Building: Provide training and capacity building programs for healthcare professionals and community workers to enhance their knowledge and skills in supporting adolescent mothers with infant and young child feeding practices.

It is important to note that the implementation of these innovations should be context-specific and tailored to the needs and resources available in the specific setting.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health is to implement health and nutritional support interventions that address the factors associated with infant and young child feeding (IYCF) practices among adolescent mothers in India.

The study found that while breastfeeding rates among adolescent mothers were relatively high, other IYCF practices such as early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were suboptimal.

The factors associated with breastfeeding practices among adolescent mothers included maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth. On the other hand, factors associated with complementary feeding practices included maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth.

Therefore, to improve access to maternal health, interventions should focus on improving maternal education, increasing ANC clinic visits, and addressing socio-economic factors such as household wealth. Additionally, targeted interventions should be implemented in specific geographical regions to address the unique challenges faced by adolescent mothers in those areas. By addressing these factors, it is expected that IYCF practices among adolescent mothers will improve, leading to better child survival and growth outcomes.

AI Innovations Methodology

The study “Infant and young child feeding practices among adolescent mothers and associated factors in India” aimed to examine the factors associated with infant and young child feeding (IYCF) practices among adolescent mothers in India. The study utilized data extracted from the 2015-2016 India National Family Health Survey (NFHS-4) and employed a multistage cluster sampling design.

The methodology of the study involved the following steps:

1. Data Collection: The data on sociodemographic, household characteristics, and infant and young child feeding practices were collected from a sample of respondents, specifically adolescent mothers aged between 15 and 19 years. The survey questionnaire used in the study was standardized and based on the NFHS-4.

2. Study Outcomes: The study focused on the 2008 IYCF indicators prescribed by the World Health Organization (WHO). These indicators included exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates.

3. Data Analysis: The study conducted both univariable and multivariable survey logistic regression analyses to examine the association between the study variables (individual-, household-, and community-level factors) and the IYCF indicators. The analyses were adjusted for clustering and sampling weights.

4. Modelling Technique: A three-staged modelling technique was adopted for the survey multivariable analyses. In the first stage, individual-level factors were entered into the baseline multivariable model. Then, a manually executed elimination method was used to determine factors associated with IYCF. In the second stage, household-level factors were added to the model, and those factors with p-values < 0.05 were retained. In the third stage, community-level factors were added to the model, and again, factors with p-values < 0.05 were retained.

5. Reporting and Analysis: Factors significantly associated with IYCF at a 5% significance level in the final model were reported. Odds ratios with 95% confidence intervals were calculated to determine the level of association of the factors.

6. Software: The statistical analysis was conducted using Stata version 14.0.

The study’s findings highlighted the suboptimal IYCF practices among adolescent mothers in India, except for breastfeeding. The factors associated with these practices included maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth for breastfeeding practices, and maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth for complementary feeding practices.

In conclusion, the study utilized a cross-sectional design and survey logistic regression analysis to examine the factors associated with IYCF practices among adolescent mothers in India. The findings can inform health and nutritional support interventions to address the identified factors and improve access to maternal health in India.

Author

Dima Health

Statistics:

Citations: 9

Identifiers:

DOI: 10.3390/nu13072376

Research Areas:

Community Interventions, Disparities, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care

Study Design:

Cross Sectional Study

Study Approach:

Quantitative