Background
Methods
Study site and sample selection
Data collection
Infant and Child Feeding Index (ICFI)
Variables | 6 – 8 Mo | 9 – 11 Mo | 12 – 24 Mo |
---|---|---|---|
Breastfeeding | Yes – 2 | Yes – 2 | Yes – 1 |
No – 0 | No – 0 | No – 0 | |
Bottle feeding | Yes – 0 | Yes – 0 | Yes – 0 |
No – 1 | No – 1 | No – 1 | |
Dietary diversity score1 (24-h recall) | 0– 1 food group – 0 | 0– 2 food group – 0 | 0– 2 food group – 0 |
2 food groups – 1 | 3 food groups – 1 | 3 food groups – 1 | |
≥3 food groups – 2 | ≥4 food groups – 2 | ≥4 food groups – 2 | |
Food group frequency score1,2 (past 7d – food frequency questionnaire) | 0 – 2 food groups – 0 | 0 – 3 food groups – 0 | 0 – 3 food groups – 0 |
3 – 4 food groups – 1 | 4 food groups – 1 | 4 food groups – 1 | |
≥5 food groups – 2 | ≥5 food groups – 2 | ≥5 food groups – 2 | |
Feeding frequency | 0 – 1 times – 0 | 0 – 2 times – 0 | 0 – 2 times – 0 |
2 times – 1 | 3 times – 1 | 3 times – 1 | |
≥3 times – 2 | ≥4 times – 2 | 4 times – 2 | |
≥5 times – 3 |
Ethics
Data analysis
Results
Sample characteristics
Nutritional status
ICFI Score
Age categories | Breastfed | Non–breastfed | All children | ||||||
---|---|---|---|---|---|---|---|---|---|
(n = 381) | (n = 65) | (n = 446) | |||||||
Male | Female | Total | Male | Female | Total | Male | Female | Total | |
(n = 95) | (n = 95) | (n = 190) | (n = 124) | (n = 132) | (n = 256) | (n = 219) | (n = 227) | (n = 446) | |
6 – 8.99 mos (n = 100) | 7.1 ± 1.7 | 6.0 ± 1.8 | 6.5 ± 1.8 | 5.3 ± 0.9 | 5.0 | 5.2 ± 0.8 | 6.9 ± 1.7 | 6.0 ± 1.7 | 6.5 ± 1.8 |
9 – 11.99 mos (n = 90) | 6.3 ± 1.7 | 5.8 ± 1.8 | 6.1 ± 1.8 | 4.3 ± 1.5 | 4.6 ± 1.7 | 4.4 ± 1.5 | 6.2 ± 1.8 | 5.6 ± 1.8 | 5.9 ± 1.8 |
12 – 17.99 mos (n = 196) | 5.4 ± 2.2 | 5.6 ± 2.0 | 5.5 ± 2.1 | 5.6 ± 0.9 | 6.1 ± 1.9 | 5.9 ± 1.6 | 5.5 ± 2.0 | 5.7 ± 2.0 | 5.6 ± 2.0 |
18 – 24 mos (n = 60) | 6.1 ± 1.9 | 6.4 ± 2.0 | 6.3 ± 1.9 | 5.1 ± 1.9 | 4.7 ± 1.2 | 4.9 ± 1.7 | 5.8 ± 1.9 | 5.8 ± 1.9 | 5.9 ± 1.9 |
All children | 6.1 ± 2.0 | 5.8 ± 1.9 | 5.9 ± 1.9 | 5.3 ± 1.4 | 5.6 ± 1.8 | 5.4 ± 1.6 | 6.0 ± 1.9 | 5.8 ± 1.9 | 5.9 ± 1.9 |
Components of ICFI
ICFI components | Male (n = 219) | Female (n = 227) | All children (n = 446) | F value, p (by gender) |
---|---|---|---|---|
Breastfeeding
| ||||
6 – 8.99 mos | 1.9 ± 0.5 | 2.0 ± 0.3 | 1.9 ± 0.4 | 15.174,0.000 |
9 – 11.99 mos | 1.9 ± 0.5 | 1.8 ± 0.6 | 1.8 ± 0.6 | |
12 – 17.99 mos | 0.9 ± 0.4 | 0.8 ± 0.4 | 0.8 ± 0.4 | |
18 – 24 mos | 0.7 ± 0.5 | 0.8 ± 0.4 | 0.7 ± 0.4 | |
F value, p (by age category)
| 161.758,0.000 | |||
Bottle-feeding
| ||||
6 – 8.99 mos | 1.0 ± 0.2 | 1.0 ± 0.1 | 1.0 ± 0.2 | 1.388,0.239 |
9 – 11.99 mos | 1.0 ± 0.2 | 1.0 ± 0.2 | 1.0 ± 0.2 | |
12 – 17.99 mos | 1.0 ± 0.1 | 1.0 ± 0.1 | 1.0 ± 0.1 | |
18 – 24 mos | 0.9 ± 0.2 | 1.0 ± 0.2 | 1.0 ± 0.2 | |
F value, p (by age category)
| 1.228,0.299 | |||
Dietary diversity scores
| ||||
6 – 8.99 mos | 1.0 ± 0.8 | 0.7 ± 0.7 | 0.9 ± 0.8 | 0.145,0.703 |
9 – 11.99 mos | 0.7 ± 0.7 | 0.5 ± 0.7 | 0.6 ± 0.7 | |
12 – 17.99 mos | 0.8 ± 0.8 | 0.8 ± 0.8 | 0.8 ± 0.8 | |
18 – 24 mos | 0.8 ± 0.8 | 0.9 ± 0.8 | 0.9 ± 0.8 | |
F value, p (by age category)
| 3.035,0.029 | |||
Food group frequency scores
| ||||
6 – 8.99 mos | 1.5 ± 0.6 | 1.3 ± 0.8 | 1.4 ± 0.7 | 0.275,0.600 |
9 – 11.99 mos | 1.8 ± 0.5 | 1.6 ± 0.7 | 1.7 ± 0.6 | |
12 – 17.99 mos | 1.7 ± 0.5 | 1.8 ± 0.5 | 1.7 ± 0.5 | |
18 – 24 mos | 1.8 ± 0.4 | 1.9 ± 0.3 | 1.9 ± 0.4 | |
F value, p (by age category)
| 3.796,0.010 | |||
Feeding frequency scores
| ||||
6 – 8.99 mos | 1.6 ± 0.7 | 1.1 ± 0.9 | 1.3 ± 0.8 | 0.059,0.807 |
9 – 11.99 mos | 0.9 ± 0.9 | 0.8 ± 1.0 | 0.9 ± 0.9 | |
12 – 17.99 mos | 1.1 ± 1.1 | 1.3 ± 1.3 | 1.2 ± 1.2 | |
18 – 24 mos | 1.5 ± 1.1 | 1.4 ± 1.2 | 1.5 ± 1.1 | |
F value, p (by age category)
| 1.267,0.285 |
ICFI components | 6 – 8.99 mos | 9 – 11.99 mos | 12 – 17.99 mos | 18 – 24 mos | All children | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Male | Female | Male | Female | Male | Female | Male | Female | Male | Female | Total | |
Breastfeeding
| |||||||||||
Yes | 93.8 | 98.0 | 93.5 | 88.6 | 85.9 | 81.7 | 68.8 | 78.6 | 86.7 | 86.3 | 86.6 |
χ
2
, p (by age)
| 2.224,0.329 | 1.567,0.457 | 0.612,0.434 | 0.737,0.391 | 0.022,0.989 | ||||||
Bottle-feeding
| |||||||||||
No | 95.9 | 98.0 | 95.7 | 97.7 | 97.8 | 98.1 | 93.8 | 96.4 | 96.3 | 97.8 | 97.1 |
χ
2
, p (by age)
| 0.386,0.534 | 0.301,0.584 | 0.015,0.901 | 0.226,0.635 | 0.829,0.363 | ||||||
Dietary diversity score
| |||||||||||
Low (0) | 26.5 | 49.0 | 50.0 | 61.4 | 45.7 | 42.3 | 43.8 | 32.1 | 42.0 | 46.3 | 44.2 |
Medium (1) | 42.9 | 35.3 | 34.8 | 27.3 | 32.6 | 34.6 | 28.1 | 42.9 | 34.7 | 34.4 | 34.5 |
High (2) | 30.6 | 15.7 | 15.2 | 11.4 | 21.7 | 23.3 | 19.4 | 21.3 | |||
χ
2
, p (by age)
| 6.113,0.047 | 1.181,0.554 | 0.222,0.895 | 1.506,0.471 | 1.257,0.534 | ||||||
Food group frequency score
| |||||||||||
Low (0) | 8.2 | 17.6 | 4.3 | 11.4 | 4.3 | 4.8 | 3.1 | 0.0 | 5.0 | 8.4 | 6.7 |
Medium (1) | 32.7 | 37.3 | 15.2 | 18.2 | 19.6 | 15.4 | 9.4 | 7.1 | 20.1 | 19.8 | 20.0 |
High (2) | 59.2 | 45.1 | 80.4 | 70.5 | 76.1 | 79.8 | 87.5 | 92.9 | 74.9 | 71.8 | 73.3 |
χ
2
, p (by age)
| 2.834,0.242 | 1.838,0.399 | 0.601,0.740 | 1.012,0.603 | 2.005,0.367 | ||||||
Feeding frequency score
| |||||||||||
Low (0) | 12.2 | 31.4 | 45.7 | 52.3 | 39.1 | 37.5 | 25.0 | 32.1 | 32.4 | 38.3 | 35.4 |
Medium (1) | 18.4 | 31.4 | 15.2 | 20.5 | 23.9 | 20.2 | 25.0 | 17.9 | 21.0 | 22.5 | 21.7 |
High (2/3)* | 69.3 | 37.3 | 39.1 | 27.2 | 37.0 | 42.3 | 50.0 | 50.0 | 46.6 | 39.2 | 42.8 |
χ
2
, p (by age)
| 10.882,0.012 | 4.584,0.205 | 5.186,0.159 | 0.774,0.856 | 11.435,0.010 |
Association of ICFI with nutritional status of children
Age category | ICFI category | n | WLZ | LAZ | WAZ | BAZ | MUACZ |
---|---|---|---|---|---|---|---|
6 – 8.99 mos (n = 100) | Low (0–5) | 37 | −1.0 ± 2.6 | −0.6 ± 2.5 | −1.3 ± 1.7 | −1.3 ± 2.4 | −0.3 ± 1.2 |
Medium (6–7) | 25 | −0.9 ± 2.5 | −0.7 ± 2.1 | −1.2 ± 1.8 | −1.1 ± 2.5 | −0.7 ± 0.9 | |
High (8–9) | 37 | −0.6 ± 2.1 | −0.4 ± 2.4 | −0.9 ± 1.5 | −0.8 ± 2.0 | −0.4 ± 1.3 | |
9 – 11.99 mos (n = 90) | Low (0–5) | 45 | −1.0 ± 2.4 | −1.1 ± 2.3 | −1.5 ± 1.4 | −1.1 ± 2.3 | −0.3 ± 0.9 |
Medium (6–7) | 23 | −0.7 ± 2.9 | −1.6 ± 2.2 | −1.5 ± 1.7 | −0.7 ± 2.9 | −0.8 ± 1.1 | |
High (8–9) | 22 | −1.4 ± 1.9 | −2.2 ± 1.9 | −2.2 ± 1.5 | −1.4 ± 1.9 | −0.5 ± 1.3 | |
12 – 17.99 mos (n = 196) | Low (0–5) | 100 | −0.1 ± 2.0 | −3.1 ± 2.3 | −1.8 ± 1.3 | 0.2 ± 1.9 | −0.8 ± 1.2 |
Medium (6–7) | 53 | 0.2 ± 2.5 | −2.1 ± 2.2 | −1.2 ± 1.4 | 0.1 ± 2.7 | −0.4 ± 1.3 | |
High (8–9) | 43 | −0.9 ± 2.0 | −2.5 ± 2.2 | −2.0 ± 1.3 | −0.7 ± 2.1 | −0.5 ± 1.3 | |
18 – 24 mos (n = 60) | Low (0–5) | 25 | −0.2 ± 1.7 | −4.7 ± 2.0 | −2.7 ± 1.2 | 0.5 ± 1.7 | −1.4 ± 1.4 |
Medium (6–7) | 18 | −0.8 ± 2.8 | −4.3 ± 2.5 | −2.9 ± 1.7 | −0.2 ± 3.0 | −1.5 ± 0.7 | |
High (8–9) | 16 | −0.5 ± 2.2 | −4.3 ± 1.8 | −2.7 ± 1.2 | 0.2 ± 2.4 | −1.1 ± 1.1 | |
F value, p (by ICFI categories)
| 0.502,0.605 | 0.245,0.783 | 0.681,0.506 | 0.447,0.640 | 0.934,0.394 | ||
Percent children with Z scores < −2 SD
| |||||||
6-8.99 mos | - | 100 | 29.4 | 9.6 | 15.1 | 32.8 | 6.0 |
9-11.99 mos | - | 90 | 26.1 | 14.8 | 21.5 | 28.6 | 5.5 |
12-17.99 mos | - | 196 | 36.1 | 52.8 | 39.8 | 32.8 | 15.3 |
18-24 mos | - | 59 | 8.4 | 22.7 | 23.7 | 5.9 | 31.6 |
Parameters | WLZ | WAZ | LAZ | BAZ | MUACZ | |||||
---|---|---|---|---|---|---|---|---|---|---|
Beta | Sig | Beta | Sig | Beta | Sig | Beta | Sig | Beta | Sig | |
Maternal characteristics
| ||||||||||
Age (yrs) | 0.050 | 0.368 | 0.093 | 0.083 | 1.001 | 0.317 | 0.684 | 0.494 | 3.008 | 0.003 |
Per capita income (Rs) | −0.038 | 0.448 | −0.042 | 0.384 | 0.075 | 0.940 | −0.976 | 0.330 | 0.122 | 0.903 |
BMI | 0.107 | 0.029 | 0.068 | 0.148 | −1.287 | 0.199 | 2.485 | 0.013 | 0.354 | 0.724 |
≤SSC | 0.157 | 0.003 | 0.085 | 0.092 | −1.888 | 0.060 | 3.237 | 0.001 | 0.041 | 0.967 |
≥HSC | 0.086 | 0.100 | 0.047 | 0.352 | −1.120 | 0.263 | 1.712 | 0.088 | −0.656 | 0.512 |
Child characteristics
| ||||||||||
Gender | 0.005 | 0.910 | 0.091 | 0.046 | 2.610 | 0.009 | −0.163 | 0.871 | 1.198 | 0.231 |
Age (months) | 0.052 | 0.273 | −0.303 | 0.000 | −11.344 | 0.000 | 3.910 | 0.000 | −4.397 | 0.000 |
Ordinal position | −0.024 | 0.679 | −0.066 | 0.230 | −0.770 | 0.442 | −0.519 | 0.604 | −1.595 | 0.111 |
ICFI score
| −0.092 | 0.056 | −0.010 | 0.827 | 2.034 | 0.043 | −2.012 | 0.045 | 0.510 | 0.610 |
R
2
(R
2
Adj)
| 0.051(0.032) | 0.115(0.096) | 0.263(0.247) | 0.093(0.074) | 0.066(0.047) | |||||
F value = 2.622, | F value = 6.266, | F value = 17.258, | F value = 4.948, | F value = 3.415, | ||||||
p = 0.006 | p = 0.000 | p = 0.000 | p = 0.000 | p = 0.000 |
Sensitivity *(95% CI) | Specificity #(95% CI) | P value | |
---|---|---|---|
WLZ | 0.236(0.191,0.282) | 0.705(0.666,0.745) | 0.164 |
LAZ | 0.545(0.494,0.597) | 0.515(0.469,0.560) | 0.218 |
WAZ | 0.435(0.384,0.486) | 0.599(0.554,0.644) | 0.501 |
BAZ | 0.230(0.186,0.276) | 0.700 (0.662,0.741) | 0.108 |
MUACZ | 0.163 (0.127,0.198) | 0.890 (0.859,0.920) | 0.126 |