Parent’s food preference and its implication for child malnutrition in Dabat health and demographic surveillance system; community-based survey using multinomial logistic regression model: North West Ethiopia; December 2017

Malnutrition is a failure of the body to get an appropriate amount of nutrients for healthy human organ and tissue function. Children were more vulnerable to malnutrition. Children who suffer from nutritional deprivation were at risk of developmental delays which can lead to different consequences [1]. In the year 2007, the Lancet estimated that about 200 million under-five children were failing to fulfill developmental potential in developing countries due to malnutrition [2]. According to the MDG report in 2012 malnourished children at adulthood are estimated to earn 20% less than their counterparts [3]. The young lives survey in its 2010 report in developing countries suggests that by of age 7 or 8 years older the malnutrition consequence is comparable to a loss of full-term schooling and is associated with the loss of 10–15 IQ points [4, 5].

The global burden of diseases suggested that underweight in young children is one of the leading cause of burden of disease in sub-Saharan Africa. It is responsible for increased years of lives with a disability for children under 5 years [5]. In 2013 almost 6.3 million children under 5 years lost their life from preventable causes and every year about 2.6 million under-five children died because of malnutrition [6].

In the year 2011 10 years after setting the goal of eradicating extreme hunger globally about 314, 258, and 52 million children below the age of five were suffering from stunting, underweight and wasting respectively [7]. Malnutrition occurring in the first 1000 days of life has long-lasting irreversible consequence including being stunting forever, susceptible to sickness, poor school performance, entering adulthood more likely to become overweight and prone to none communicable disease [8].

Malnutrition is a priority problem since the 1970s but not addressed yet because it may be related to mothers/caretakers food preference uninvestigated fact but have potential to affect safety, diversity, acceptability, and frequency of food basic dimensions for good nourishment of children [9]. Another nutrition-related emerging public health problem more prominently related to food preference is an increased rate of overweight and expected to nearly double again by 2025 but not yet investigated well in middle and low-income countries [10].

It is agreed on the fact that no child is born to die from the cycle of malnutrition and our world is believed to have enough food for every one of us [3]. However, currently available evidence on child malnutrition was limited to determine the prevalence of malnutrition and revealed that 40% of under-five children in the globe were experiencing hunger. On the contrary works in FAO shows that world agriculture can produce enough to feed humanity indicating that there is an uninvestigated fact that probably related to parental food preference. We hypothesize that mothers/caretakers food preference may be the main contributor for child malnutrition which negatively interacting-with quality, diversity, frequency, safety, acceptability, and quantity of food in addition to ensuring food security and healthcare [11, 12]. Therefore this study was intended to generate information on the parent/caretakers food preference and its implication for child malnutrition in Dabat health and demographic site for national, regional and local decision-makers.

About 6896 participants were willing to respond for the interview making the response rate of 97.4%. Almost half (50.5%) of children were female. More than three-fourths (79.86%) and two-thirds (68.00%) of mothers /caretakers were rural residents and farmers by occupation. Majority of mothers/caregivers (81.20%) were Orthodox Christians and 86.29% were currently married. A large proportion (74.23%) of households with under-five children had a garden to grow cereals and grains (Table 1).

Diversification and balancing of food are the strategies to address the nutritional problem of children. In this study, only 21% of mothers/caretakers prefer to feed a balanced diet, 62.55% of prefers to feed family food and 16.45% prefers to feed specific type of food for children. Preferring to feed children with family and specific type of food imply child malnutrition as it harms dietary diversity and dietary frequency contributors for child malnutrition [14, 15]. This explanation was supported by evidence that reported the possibility of reducing the odds of stunting with increased dietary diversity [16‐21]. In our study area, child malnutrition is a major problem where 40, 9, 25% of children were stunted wasted and underweight respectively that may be mainly attributed by inappropriate food preference by mothers/caretakers evidenced by the result of this study [22].

In this study area, about 68% of participants were farmers who have two possible options to feed their under-five children. The first option is feeding children as adult members in the morning and at night, difficult to attain minimum acceptable food diversity and frequency issues strongly associated with increased odds of child malnutrition [18, 23]. The second option would be a takeover of cooked food to the farmland and feeding the child the whole day the takeover food. These options have to be questioned against its safety which worsens their health condition another issue which has strong implication child malnutrition [23‐28].

Mothers/caretakers who were unable to read and write, introduce semisolid food after 6 months and walk more than 4kms to market were 2.19(1.09–4.40), 2.34(1.50–3.96) and 1.41(1.17–1.70) times respectively more likely to prefer to feed their under-five children with a family food than balanced diet in this study. The association between the above three factors and feeding a child with a family food may be explained by the fact that those unable to read and write, introduce semisolid food before 6 months and walk more than 4kms to the market to obtain food would be unable to comply with appropriate child feeding recommendations due to the inaccessibility of health, nutritional or child food conditions which have implication for child malnutrition by interfering with safety, diversity, and frequency of child food [28].

Similarly, mothers/caretakers who introduce semisolid food after 6 months were and obtain food items from the market were 6.53(3.8–11.24) and 4.38(3.45–5.56) times more likely to feed specific type of food for under-five children than feeding with a balanced diet. The association of late introduction of semi-fluid food and preference to feed a child with a specific type of food may be due to miss understanding of child feeding practice as the main reason of preference to feed a specific type of food for about 53% of the participants in this study was improving child health. Similarly, positive association between walking a far distance to the market and preference feed a specific type of food may be due to the difficulty of buying diversified food frequently as almost all those who buy food in this study walks on foot to the market. Such specific food preference for any reason has a contribution for child malnutrition as it has a direct effect on reduced diversity of the child food evidenced Chinese study that showed to a reduced score of height for weight with reduced dietary diversity [29].

On the other hand, exclusively breastfeed a child for 6 months 58% (34–74%), breastfeed for 2 years 20%(4–36%) and having 3 years birth interval between births 45%(19–63%) were associated with a decreased odds of preferring to feed a child with family food. In all of the above cases, mothers/caretakers may be better informed about appropriate child feeding practice and family planning service strategies to address child malnutrition [30].

Continuing breastfeeding for 2 years 79%(62–88) and buy food in 2 weeks frequency 34%(16–93%) were also associated with the decreased odds of preferring to feed a child with the specific type of food. Inverse association between increased duration of breastfeeding and preferring to feed a child with a specific type of food may be due to having better information on child feeding practice which has a great contribution to reduce child malnutrition. Similarly, the inverse relationship between an increased frequency of food buying and preferring to feed balanced diets for children could be associated with better access to infrastructure and food security, the major contributor for better child nourishment [31].

The main limitation of the study was that data were collected only from mothers/caretakers where involvement of both parents may better supplement the evidence.

Despite the local availability of recommended diversity of food for the feeding of under-five children in the study are about 79% of mothers or caretakers of under-five children prefer to feed their children either family food (cooked for adult family) or a specific /monotonous/ type of food more than once a day having direct effect on reduction of dietary diversity, safety and acceptability of child food that intern might contribute for the increased and sustained prevalence of under-five malnutrition against efforts to reduce the magnitude in the study area and the nation at large. Therefore we recommended integration of child dietary diversity counseling session for mothers visiting health institution for ANC, PNC and immunization services and health professionals with IMNCI care and treatment guidelines.