A child feeding index is superior to WHO IYCF indicators in explaining length-for-age Z-scores of young children in rural Cambodia

Abstract

Background:

Adequate young child feeding practices are influenced by a multitude of factors which affect growth and development. A combination of indicators is needed to explain the role of complementary feeding practices in growth retardation.

Methods:

A cross-sectional nutrition baseline survey was conducted in rural Cambodia in September 2012. Villages in pre-selected communes were randomly selected using stunting as a primary indicator. Data were collected from 803 randomly selected households with children aged 6–23 months, based on a standardised questionnaire and on length/height and weight measurements of mother and child. WHO Infant and Young Child Feeding (IYCF) indicators [minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD)] and a child feeding index (CFI) were created. The latter consisted of five components: breastfeeding, use of bottle, dietary diversity, food frequency and meal frequency which were adjusted for three age groups: 6–8, 9–11 and 12–23 months. The highest possible score was 10. Associations between length-for-age Z-scores (LAZ) and WHO indicators or CFI were explored.

Results:

Mean (SD) LAZ was −1·25 (1·14) (n  =  801). Mean (range) CFI was 6·7 (1–10) (n  =  797). Mean CFI was highest in the 9–11-months age group (7·93) and lowest for those aged 12–23 months (5·96). None of the WHO IYCF indicators was associated with LAZ, whereas CFI showed significant association with LAZ (P < 0·01). The association between higher CFI scores and LAZ became weaker as age increased.

Conclusion:

The results highlight the need to include a wide range of information in the analysis in order to understand the association between appropriate infant feeding practices and child growth.

Keywords:

• Complementary feeding
• Child feeding index
• Length-for-age Z-score
• Cambodia

Acknowledgments

The authors thank the staff of the FAO MALIS project in Siem Reap, Cambodia, especially Dr Iean Russell, Mr Ly Koung Ry, Mr Chea Chantan, Mr Sam Samnang, Mr Khin Mengkheang, Mr Yann Phanith, for support during the survey preparation and data collection. The support of the Provincial Health Departments of Preah Vihear and Oddar Meanchey Provinces is gratefully acknowledged. The team thanks Dr Koung Lo of the Provincial Hospital of Preah Vihear. Our thanks also go to the enumerators and drivers and to the translators during the training. The support and technical input by FAO Rome, Dr Gina Kennedy, Ms Theresa Jeremias and Dr Elizabeth Westaway is greatly appreciated.

Notes

ⁱAs 2012 was a leap year with 366 days, children aged 731 days were counted as children aged 0–23 months.

ⁱⁱNo bottle feeding does not mean no liquids were given; liquids besides breast-milk are not considered in this index. Bottle feeding is regarded as harmful mainly for reasons of hygiene.

ⁱⁱⁱSanitation facilities as classified by UNICEF/WHO: improved  =  facilities that ensure hygienic separation of human excreta from human contact; unimproved  =  facilities that do not ensure hygienic separation of human excreta from human contact³⁰

^ivSource of drinking water as classified by UNICEF/WHO: protected/improved  =  sources that, by nature of their construction or through active intervention, are protected from outside contamination, particularly faecal matter; unprotected/unimproved  =  unprotected dug well, unprotected spring, cart with small tank/drum, tanker truck, and surface water, bottled water.³⁰