Abstract
The measurement of child feeding practices
is complex and the relation between the quality of feeding and
children's nutritional
status is difficult to establish. We examined this
relation in rural Burkina Faso, West Africa, using an adapted version of
the Infant and Child Feeding Index (ICFI). A
cross-sectional study was conducted on a random sample of children (n = 2466) aged 6–35 mo in 2002. Feeding practices were assessed through a qualitative 24-h recall. ICFIs were made age specific
for children aged 6–11 mo (n = 614), 12–23 mo (n = 987), 24–35 mo (n
= 865), and were divided into terciles. The association between
height-for-age Z-scores (HAZ), weight-for-height Z-scores
(WHZ), and ICFIs were examined separately in each
age group. Multivariate analyses were performed to control for
sociodemographic
and economic factors. Adjusted mean HAZ in low,
medium, and high categories of ICFI were, respectively, −1.67, −1.53,
and
−1.21 (P = 0.003) among children aged 6–11 mo; −2.54, −2.24, and −2.11 (P = 0.0002) among children aged 12–23 mo; and −2.18, −2.20, and −2.45 (P = 0.05) among children aged 24–35 mo. There was also a positive association between ICFI and WHZ in children aged 12–23 mo
(P = 0.05) but a negative association in children aged 6–11 mo (P
= 0.02). Among the components of ICFI, dietary diversity or variety
scores and frequency of meals or snacks supported the
positive associations with anthropometric indices,
except for WHZ in children aged 6–11 mo, whereas breast-feeding
exhibited
a reverse association among older children. A
suitable ICFI and/or some of its components could be used to identify
vulnerable
age groups and to monitor interventions in similar
rural areas of Africa.
Breast-feeding and complementary feeding practices are fundamental to children's survival and development (1).
In many developing countries, nutritional problems in infants and young
children are closely linked to these practices.
Among other things, feeding practices have an impact
on physical growth, which is regarded as one of the best indicators of
children's well-being (2).
However, the relation between the quality of feeding practices during
early age and nutritional status are difficult to
establish, and, depending on the context and overall
living conditions, the influence of feeding factors on children's
nutritional
status can vary considerably (3).
In addition, feeding practices are often complex, change with a child's
age, and are seldom all positive or all negative.
It is therefore not easy to assess the global quality
of feeding practices at the scale of the individual child. In 2002,
Ruel and Menon (4) proposed an Infant and Child Feeding Index (ICFI)3
based on an age-specific scoring system that gives points for positive
practices in terms of breast-feeding, bottle-feeding,
meal frequency, and food diversification. This method
takes into account the young child's main feeding practices and
expresses
them comprehensively through a single summary index.
Such an approach has many potential advantages: it summarizes
information,
facilitates an exploratory diagnosis in a particular
situation, and helps target and monitor specific interventions. It may
also enable comparisons at an international scale.
Using the Demographic and Health Surveys data of 7 Latin American
countries,
the authors showed that the ICFI was closely related
to the mean height-for-age Z-score (HAZ) among children aged 12–36 mo
(5).
In a later study, the same authors showed that a dietary diversity
index calculated over 1 wk, which was one of the components
of ICFI, was also related to HAZ (6).
This study again used the Demographic and Health Surveys data, but this
time in 11 developing countries, including some
African countries, and it examined a narrower age
range of children, 6–23 mo. To our knowledge, only one published study
has
considered this kind of relation between ICFI or its
components and the nutritional status of young children at a
smaller-than-national
scale, i.e., in a more homogenous sample (7). Conducted in an African rural area of Senegal, the study found that ICFI was not associated with either height-for-age
or the linear growth of children aged 12–42 mo.
We examined the relation between feeding
practices and nutritional status of infants and young children living in
rural Burkina
Faso, West Africa. The data are from a cross-sectional
study conducted in 2002 and are based on a representative sample of
over 2400 children aged 6–35 mo. We followed the
principles of the method proposed by Ruel and Menon (5)
to build a composite index of ICFI, which, in our study, was adapted to
the characteristics of the context and to available
data. The relation between this index and its
different components with the children's nutritional status were
explored separately
in 3 age groups (6–11, 12–23, and 24–35 mo). The consistency between the index and its different components was also studied.
SUBJECTS AND METHODS
Setting.
Gnagna province is located in
northeast Burkina Faso and ranks among the poorest areas of the country
owing to climate aridity,
low quality of soils, and a landlocked
position. The population consists of ∼350,000 inhabitants unequally
distributed in
278 villages. The Gourmantche is the main ethnic group. The mean population density is 41 inhabitants/km2. The main livelihood of the population is farming and stock breeding.
Sampling.
Eighty villages were randomly
selected with a probability proportional to their population, based on
data from the 1998 administrative
census. Within each village, 12 collective
housing units (or “compounds”) were randomly selected from an updated
list of all
the heads of households currently living in
the village. All children aged 6–35 mo and their mothers, living in the
same compound
as the selected heads of households, were
included in the study.
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