30.4.10 Analysis of Baseline Survey for: CARE CENTROAMERICA, … · 2011. 1. 14. · 30.4.10 Analysis of Baseline Survey for: CARE CENTROAMERICA, NICARAGUA. PROYECTO VENTANA DE OPORTUNIDAD

30.4.10 Analysis of Baseline Survey for:

CARE CENTROAMERICA, NICARAGUA. PROYECTO VENTANA DE OPORTUNIDAD

Hilary Creed-Kanashiro, Margot Marin

Instituto de Investigación Nutricional (IIN) Lima, Perú

Final report April 2010

INTRODUCTION Nicaragua is a Central American country with a population of just under 6 million. It is one of the least developed of the region with almost half of the population living in poverty and 17% in extreme poverty, higher in rural than urban areas. The population is of mixed ethnic origin and is also a young population with more than half under 17 years of age. Nicaragua has several public health and nutrition problems but progress has been made in recent years. Infant mortality rates decreased from 58 per 1,000 births in 1992-93 to 39 in 2001, but since then have only reduced slightly to 29 in 2006 (ENDESA 2006/7). Child malnutrition rates at the national level have also decreased: stunting or chronic malnutrition in children under 5y has diminished from 25% in 1998 to 20% in 2001 and in 2006/7 was 17.5% (NCHS reference standard), although wide disparities between urban (12.3%) and rural (22.6%) areas exist. Nicaragua has a significant public health problem of Vitamin A deficiency in both children and pregnant women and anaemia is prevalent, particularly in these same vulnerable groups. However there have been several national interventions to address these problems. These include fortification of sugar with Vitamin A since 2000, Vitamin A supplementation for children under 5y and postpartum women and fortification of wheat flour with iron, thiamin, riboflavin, niacin and folate since 1997 (Mora 2007). Infant feeding practices as described in ENDESA 2006/7 are not optimum. Although most mothers in this national survey (94.5%) started breastfeeding, the giving of prelacteal feeds was not uncommon and exclusive breastfeeding amongst infants 0 – 3 months of age is quite low, 37.9%, having decreased since 2001 (39.3%) but higher than in 1998 (29.5%). The current rate is lower than some other countries in Latin America (Update USAID). Inadequate introduction of complementary foods was also described. In many rural areas there is difficulty of access to health and nutrition services. In recent years the MOH has established several programmes to address this such as the AIN-C (Integrated child attention in the community) and PROCASAN (Community programme of health and nutrition) in which education and communication strategies are an integral component (Mardini). In this context CARE Centro America in Nicaragua is implementing a project with the objective of improving infant and maternal feeding practices for better nutrition and the

growth and health of young children and their mothers in specific districts. A baseline survey for this Project “Ventana de Oportunidad” has been conducted, with data collected on infant and young child (IYC) nutritional status (anthropometry) and feeding practices in a cross-sectional sample of 1152 children and their mothers from four districts, each with intervention and control participant communities. The instrument that was applied was developed locally, but is similar to that currently being tested by WHO and other organizations to measure infant feeding practices for the recently defined and published updated infant feeding indicators (WHO Indicators for assessing infant and young child feeding practices). We have analyzed this baseline data and present the results according to the IYCF and other indicators of the project for the intervention and control populations. METHODOLOGY Data management and analysis The data was received from CARE as an Access file. It was first reviewed to detect abnormal values, outliers, inconsistencies and doubts regarding each of the variables in the 7 sections of the survey instrument, both at the individual level and in relation to the other variables. The number of registries and variables were checked within each section and any duplicate values identified. The ranges and logical values for each variable were checked. All queries were consulted with Lic. Carlos Rojas with whom criteria for validity, inclusion/exclusion and any modifications were discussed and corrections made where necessary. SPSS version 17 was used for the data checking and analysis. Exclusions from the analysis included 15 children for the anthropometry analyses as they were outliers as defined by the NCHS or WHO 2006 growth standard references as described below in section 3. Ten cases were identified that reported the infant received no liquid during the first 3 days after birth; this was confirmed against the survey forms and it was decided to do the analysis with and without these 10 cases; in fact there were no differences in the results with their exclusion. According to the characteristics of each variable the corresponding statistical test was applied. In the case of categorical variables, for the comparison of proportions between intervention and control, Pearson's Chi square test was applied where the expected frequencies were greater than 5; when it was found that at least one of the expected frequencies was less than 5 we proceeded to make the correction of continuity or Yates’ correction, typically used in CHI-square analysis with 1 degree of freedom where expected frequencies of less than 5 are found. For the comparison between intervention and control for the continuous variables a variance analysis was conducted. In all cases if the p-value was < 0.05 it was considered statistically significant. In the analysis we assumed that there was only one child younger than 24 months per household, as duplicates were not found in the identification code RESULTS The results are presented according to the terms of reference and the IIN analysis proposal, with the incorporation of the additional indicators and components requested by CARE in March 2010.

Description of the population Four districts were included in the baseline survey, with intervention and control communities in each. The total number of children included in the survey was 1152 of which 722 were from the intervention communities and 430 from control. The distribution of the sample from the different districts is shown in the following table.

Table 1 Baseline population by district and study group (control or intervention)

Control Intervention Total n % n % n % Rancho Grande

79 18.4 248 34.3 327 28.4

El Cúa 110 25.6 136 18.8 246 21.4 Waslala 152 35.3 105 14.5 257 22.3 Bavay 89 20.7 233 32.3 322 28.0 Total 430 722 1152 In most cases the person providing the information in the survey (the informant) was the mother of the child (99% intervention and 98.8% control). In 2 cases in the intervention group the father was the informant and in 5 cases for both intervention and control it was the grandmother. The mean age of the mother was 25.3 years, similar between intervention and control groups, ranging between 14 and 58 years for the intervention group and between 14 and 44 years for the control group (see Table 1A in Appendix). The median age was 25 years and 24 years respectively for control and intervention groups. Table 2 shows the education level of the informant. A high proportion of those interviewed were illiterate (30.9%) or with some, incomplete primary schooling (47.2%). The education levels of the informant are the same between intervention and control groups.

Table 2 Education level of informant

Control % Intervention % Total % Illiterate 31.4 30.6 30.9 “Literate” 4.7 3.6 4.0 Primary incomplete 47.0 47.4 47.2 Primary completed 12.8 13.3 13.1 Some Secondary education or higher 4.2 5.1 4.8

The age of the child at the time of the survey was calculated from the birth date. This was obtained mostly from the growth monitoring carnet (86.0% control, 91.1% intervention) or the birth certificate (1.6% control, 1.0% intervention) or other non-specified document (11.9% control, 7.9% intervention). For only 2 children in the control group was there no birth date. 50.7% of the children were female, 49.3 % male, similar between control and intervention groups.

Section 03 of the survey instrument: Anthropometry. Children were measured for length and weight. All length measurements were done in a supine position as the children were under 2 years. Nutritional status of the children has been calculated using both the NCHS growth reference standards and the more recent, internationally adopted WHO 2006 (WHO) standards (WHO Anthro 3.01 April 2009) A total of 1137 children were included in the nutritional status analysis. Fifteen children were excluded as they were outside the accepted range for either the NCHS or WHO reference standards, shown in the appendix Table 2A. Twelve children were outside the NCHS range for one of the indicators and 7 for one of the WHO indicators (4 of these were the same as for NCHS plus 3 additional children). All 15 were excluded so that the evaluation of nutritional status by the two reference standards was of the same population. Nutritional status Z-scores using WHO 2006 and NCHS reference standards Under nutrition The description of the anthropometric Z-scores is presented by age group for intervention and control populations in the Appendix (Tables 3A – 8A). Using the WHO 2006 reference the mean length for age Z-score is -0.38 for infants 0 – 5.9 months and decreases with age, reaching a mean of -1.45 for the 12 – 23 age group (Table 3A), a typical growth faltering pattern of developing countries. The HAZ-scores are similar between control and intervention groups. Similarly, weight for age decreases with increasing age although less than for length. The mean Z-score is -0.21 (+1.06) for infants 0 – 5 months, and reaches -0.56 (+1.10) for the 12 – 23 month age group (Table 4A). The control group has a significantly lower Z-score than the intervention population for the youngest age group (p=0.047) but for the other ages the Z-scores are similar between groups. The WHZ-score is around 0 for each age group, indicating that this is not a population with wasting (Table 5A). However there are small but significant differences between intervention and control for the youngest 2 age groups, showing a lower mean WHZ for the control group. Using the NCHS reference standards the tendencies for the Z-scores are similar to those using the WHO standards although there are some differences in the values, shown in Tables 6A – 8A. The mean HAZ ranges from -0.25 (+0.89) for infants 0 – 5 months to -1.39 (+1.16) for the 12 – 23 month age group (Table 6A), values higher than when using WHO 2006 but with no significant differences between intervention and control populations. Mean WAZ ranges from 0.22 (+0.99) for infants 0 – 5 months to -0.97 (+1.07) for the oldest age group, but in this case giving lower values than for WHO (Table 7A). Similarly the mean WHZ is lower using the NCHS reference than for WHO, but showing the same significant differences between intervention and control groups for the 2 youngest age groups (Table 8A). Tables 3-5 show the proportion of IYC with under nutrition according to the WHO reference standards. The proportion of children with stunting starts at 4.8% for the younger age group and increases with age, reaching a high prevalence of 30% in the 12 – 23 month age group (Table 3). There are no differences between control and intervention groups.

Table 3 Proportion of IYC stunted, with HAZ below -2sd, by age and study groups

WHO 2006 Age group

(months % IYC < - 2sd Chi-square

p value Control (C) Intervention

(I)

Total

0 – 5.9 3.8 5.5 4.8 0.549 6 – 11.9 13.8 18.0 16.5 0.304 12 – 23.9 30.7 28.8 29.5 0.637

Total 19.0 19.8 19.5 0.737

Similarly, the proportion of children with low weight for age starts at 4.5% and also increases with age but less than for stunting, reaching around 9% for the 12 – 23 month age group (Table 4). There are no differences between intervention and control populations.

Table 4

Proportion of IYC with WAZ below -2sd, by age and study groups WHO 2006

Age group (months

% IYC < - 2sd Chi-square p value

Control (C) Intervention (I)

Total

0 – 5.9 5.8 3.6 4.5 0.602 ª 6 – 11.9 6.9 7.7 7.4 0.780 12 – 23.9 7.8 9.3 8.7 0.574

Total 7.0 7.5 7.3 0.796 ª = with Yates’ correction

Table 5 shows that the mean wasting (low weight for height) is 4.5 – 2.2% of children according to age group. However, there is a significant difference between control and intervention groups for the 6 – 11 month age group, however this represents very few children.

Table 5

Proportion of IYC with WHZ below -2sd, by age and study groups WHO 2006

Age group (months

% IYC < - 2sd Chi-square p value ª

Control I Intervention (I)

Total

0 – 5.9 3.8 4.8 4.5 0.933 6 – 11.9 6.2 0.9 2.8 0.009* 12 – 23.9 2.6 1.9 2.2 0.842


Tables 6 – 8 show the proportion of IYC with malnutrition according to NCHS reference standards. The pattern of increasing stunting prevalence with increasing age is similar to that for the WHO standards but showing a lower proportion of children stunted than with the WHO standard across age groups. The results are similar between control and intervention groups.

Table 6

Proportion of IYC stunted, with HAZ below -2sd, by age and study groups NCHS

Age group (months


Control I Intervention (I)

Total

0 – 5.9 2.9 2.4 2.6 1.000 ª 6 – 11.9 8.5 14.6 12.4 0.089 12 – 23.9 25.5 26.5 26.1 0.805


Low WAZ increases with age from 1.1% in the youngest age group reaching 15% for the 12 – 23 months age group using the NCHS standards (Table 7). This is higher than with the WHO standards.

Table 7

Proportion of IYC with WAZ below -2sd, by age and study groups NCHS

Age group (months



Total

0 – 5.9 1.0 1.2 1.1 1.000 ª 6 – 11.9 6.2 8.6 7.7 0.405 12 – 23.9 14.6 15.3 15.0 0.819

Total 8.7 9.8 9.4 0.517 ª = with Yates’ correction In general there is a lower proportion of wasted children (low WHZ) using the NCHS standards than with WHO, and showing a tendency to increase with age (Table 8). There are no significant differences between control and intervention populations.

Table 8 Proportion of IYC with WHZ below -2sd, by age and study groups

NCHS Age group

(months % IYC < - 2sd Chi-square

p value Control (C) Intervention

(I)

Total

0 – 5.9 0.0 0.6 0.4 1.000ª 6 – 11.9 3.8 0.9 1.9 0.113 12 – 23.9 3.1 3.5 3.4 0.814

Total 2.6 2.0 2.2 0.495 ª = with Yates’ correction In summary, the above tables show that the there are differences in Z-scores of the IYC in this population when using the WHO 2006 or the NCHS reference standards, to be expected from comparisons made in other countries. For length for age, the mean Z-scores are slightly higher when using the NCHS standards than for the WHO standards for the youngest age group, 0 – 5.9 months, similar for the middle age group and again higher with NCHS for the 12 – 23.9 month age group. In the case of weight for age the mean Z-score values for this population are higher using the WHO standards except for the youngest age group, and in the case of weight for length, higher Z-scores are found with the NCHS for the youngest age group, similar values between the 2 standards for the 6 – 12 months but higher with the WHO standards for the children 12 – 23.9 months. When comparing the proportion of the population with under nutrition between the 2 reference standards, as defined by <-2sd, there is a higher proportion of stunted children with the WHO 2006 standards than with the NCHS in all age groups, also as expected. In the case of weight for age there is a higher proportion of children below -2sd in the youngest age group when using the WHO standards, a similar proportion for the middle age group but a higher proportion for the 12 – 23.9 month age group with the NCHS standards. In general the nutritional status for under nutrition is similar between the control and intervention groups. There are however significant differences between these 2 groups for Z-scores for weight for length (WHZ) for children 0 – 11.9 months using both NCHS and WHO standards although the proportion of children with low WHZ is similar, with the exception of 6 – 11.9 months using the WHO standards. Differences are also found using the WHO standards for weight for age Z score for the 0 – 5.9 months age group. There is a difference in the proportion of children 6 – 11.9 months with <-2sd weight for length for the WHO standards between study groups. Overweight and obesity As well as under nutrition there is growing concern about overweight in IYC and the risks this can bring in later life. The following categories of Z-scores for weight for height (length) are used to assess overweight and obesity for both WHO 2006 and NCHS reference standards: Z-score WHZ: 1 – 2 = possible rick for overweight

2.01 – 3 = overweight >3 = obese

In addition WHO 2006 assesses this condition using BMI for age, using the same categories. Table 9 shows the WHZ for overweight and obesity for all IYC 0 – 23 months of age by study group using the WHO reference standards. The prevalence is low prevalence: a total of 3.8% of the children classified as overweight and under 1% obese in this age range. However there are 19% of children classified as possible risk for overweight as defined by WHO. The distribution is similar between intervention and control communities.

Table 9 Overweight and obesity for IYC 0 – 23 months by study group

WHO 2006 WHZ Control Intervention Total* 1 – 2 possible risk overweight

17.6 19.5 18.8

2.01– 3 overweight

4.0 3.7 3.8

>3, obese 0.2 1.3 0.9 *Chi-square = 0.164 The prevalences for overweight and obesity by age and study group is shown in Table 9A in the appendix. There is a tendency for overweight and obesity to decrease with increasing age, from 6.7% in the youngest age group to 3.6% in the oldest, although the risk for overweight is less in the youngest group than the 2 older groups. The prevalences are similar between intervention and control groups although there is a small but significant difference for infants 6 – 12 months. The WHO 2006 reference standards allow the calculation of BMI for age for these young children. The prevalences of possibly at risk of overweight, overweight and obese using this indicator for children 0 – 23 months, shown in Table 10, are very similar to the results presented above, with a prevalence of overweight and obesity of 5.7%, and no differences between study groups. However there are some differences in the patterns by age group with a higher prevalence of possible at risk for overweight in the older age group (24.6%) (Table 10A). There is a tendency for a higher prevalence in the intervention group but this only reaches significance in the infants 0 - 6 months.

Table 10 Overweight and obesity BMI for age, children 0 - 23 months by study group.

WHO 2006 BMI for age Control Intervention Total* 1 – 2 possible risk overweight

18.1 20.4 19.5


5.2 4.6 4.8

>3, obese 0.5 1.1 0.9 *Chi-square = 0.320

Using the NCHS reference standard 4.4% of children under 2 years are classified as overweight or obese, values similar to the WHO reference (Table 11). However 13.6% of children is classified as at possible risk for overweight, a lower proportion than with the WHO reference. Table 11A in the appendix shows the rates of overweight by age and study groups. There is a higher prevalence of overweight and obesity in the children in the youngest age group (7%), decreasing with age to 2.2% at 12 – 24 months, but the proportion is small. The higher rates in the youngest children probably reflect the growth pattern of breastfed children when using NCHS. There are no differences between intervention and control groups.

Table 11 Overweight and obesity for IYC 0 – 23 months by study group

NCHS WHZ Control Intervention Total* 1 – 2 possible risk overweight

13.8 13.5 13.6


2.8 4.1 3.6

>3, obese 0.2 1.1 0.8 *Chi-square = 0.276 In summary there is a low proportion of IYC with overweight or obesity in this population and the prevalences using the different reference standards are similar. Also there is a similar pattern between intervention and control groups. Overweight and breastfeeding pattern. This data was used to explore a relationship between overweight and breastfeeding practices in this population. Using the WHO 2006 standards we present results of overweight with exclusive breastfeeding in infants under 6 months (Table 12) and for continued breastfeeding for children 12-15 months (Table 13). There is an apparent tendency for higher rates of possible risk for overweight amongst infants not exclusively breastfed, but there is no difference in prevalences of overweight or obesity. This is also a small sample and no definitive association is indicated. When using BMI the results are similar between the 2 groups as shown in Table 12A in the appendix.

Table 12 Proportion of overweight infants (WHZ) according to breastfeeding practice for

infants 0 – 6 months. WHO 2006.

WHZ % of infants exclusively breastfed that are at risk,

overweight or obese (Total n=148)

% of infants that are not exclusively breastfed that are at risk, overweight or

obese (Total n=121)

1 – 2 possible risk overweight

10.8 19.8

2.01– 3 overweight 6.1 5.0 >3, obese 0.7 1.7

For continued breastfeeding at 12 – 15 months there appears to be a tendency for a greater proportion of children to be at possible risk of overweight amongst those not breastfeeding (Table 13). A similar tendency, although with higher prevalences, is found with BMI for age (Table 13A). However, with the small sample size, especially of the children not receiving breastmilk at this age, as well as the extremely low prevalences of overweight and obesity at this age, no association can be concluded.

Table 13 Proportion of overweight infants (WHZ) according to breastfeeding practice for

children 12 – 15 months. WHO 2006.

WHZ % of children breastfeeding 12-15

months that are at risk, overweight or obese

(Total n=168)

% of infants not breastfed 12 – 15 months

that are at risk, overweight or obese

(Total n=30) 1 – 2 possible risk overweight

17.3 30.0

2.01– 3 overweight 1.8 0 >3, obese 0.6 0 Section 04 of survey instrument: Child’s feeding history. Infant and young child feeding core indicators are presented using the definitions in: Indicators for assessing infant and young child feeding practices. Part I. Definitions. WHO 2008. The complete sample of 1152 children was used for these analyses. a. Table 14 shows early feeding practices during the first 3 days after the birth of the infant. Almost all mothers gave breastmilk but 24% gave another liquid or drink during that time. This was most frequently sugared water, milk or tea or coffee. Honey was given to 5% of infants. The early breastfeeding (BF) initiation indicator, putting the infant to the breast within 1 hour of birth, was calculated using the following formula.

Children 0 – 24 months who were put to the breast within 1 hour of birth x 100 Total number of children 0 – 24 months of age

Table14 Infant and young child early breastfeeding practices by study group

Early feeding practice Control

% Intervention

% Total

% Chi-square

p value N 430 722 1152 Breastfed at any time 98.4 97.6 97.9 0.404 Proportion of IYC 0 – 23.9 months put to breast within 1 hour of birth

76.3 74.8 75.3 0.571

During the first 3 days after birth did child receive any other liquid/drink:

23.0 24.9 24.2 0.465

Received water 3.0 1.9 2.3 0.239 Received water with sugar

4.7 8.3 6.9 0.018*

Received cow’s milk 7.2 5.0 5.8 0.119 Received infant formula 1.9 2.5 2.3 0.484 Received honey 6.7 4.0 5.0 0.041* Received coffee/tea 5.3 3.9 4.4 0.240 Received rice water 0 0 0 Received other liquid 2.3 2.2 2.3 0.904 Early BF, putting the baby to the breast within the first hour, was reported by 75.3% of mothers, similar between study groups (Table 14). Early breastfeeding was further explored by place of birth: institutional or home. Table 15 shows the percent of infants put to the breast during the first hour after birth for institutional or home births. It can be seen that the majority of infants, were put to the breast within the first hour, although this was significantly higher for institutional births, and similar between intervention and control communities.

Table 15 Early breastfeeding practice by place of birth

Place of birth

Put child to breast within 1 hour

Put child to breast after 1 hour

C I Total C I Total Institutional n 188 280 468 38 91 129 % 83.2 75.5 78.4 16.8 24.5 21.6 Home n* 140 260 400 63 88 151 69.0 74.7 72.6 31.0 25.3 27.4 *4 children excluded as information missing on place of birth p=0.026 between institutional and home births. p=0.117 between intervention and control populations.

b. Exclusive breastfeeding for infants under 6 months Table 16 shows the infant feeding practices during the first 6 months of age. Most mothers breastfed (94%) but other liquids, particularly water, cow’s milk and “fresco” were also given. Patterns were similar between control and intervention groups although there was a higher use of fresco in the intervention group.

Table 16 Feeding practices (during the previous day or night) of infants 0 – 5.9 months by

study group Control

% Intervention

% Total

% Chi-square

p value n 108 170 278 Breastfed (yesterday) 94.4 94.1 94.2 0.909 Received vitamins 6.5 2.4 4.0 1.000ª Received rehydration salt solution

0.0 2.4 1.4 0.276ª

Received water or water with sugar

13.0 17.1 15.5 0.357

Received infant formula 0.9 1.2 1.1 0.844 Received cow’s milk 19.4 20.6 20.1 0.817 Received “fresco” 8.3 21.8 16.5 0.003* Received soup 5.6 9.4 7.9 0.246 Received coffee, tea 1.9 5.9 4.3 0.191ª Received honey 0 1.8 1.1 0.428ª Received “atol” 4.6 2.4 3.2 0.296 ª = with Yates’ correction The exclusive breastfeeding indicator was calculated using the following formula. The definition of exclusive breastfeeding (EBF) allows the inclusion of ORS and/or vitamins. Infants 0 – 5 months who received only breast milk during the previous 24 hours x 100

Total number of infants 0 – 5 months of age Figure 1 and table 14A show the prevalence of EBF for different age groups. 56.5% of infants 0-5.9 months were reported to be exclusively breastfed; 60.2% in the control group and 54.1% in intervention. 80.7% of infants were EBF in the first month and this decreased to 26% at 4 – 5 months. Breastfeeding patterns were similar between control and intervention groups, except for the older age group where there was a considerably higher rate of EBF in the control group. The “n” in table 14A is the sample for each of these age groups; care needs to be taken in the use of the indicators for those age groups where the sample is small, specifically for the for the 2 monthly age group intervals.

Figure 1

Exclusive breastfeeding of infants 0‐5.9 m by study group

60.254.1 56.5

0

20

40

60

80

100

Control Intervention Total

Prop

ortion

of infant

c. Continued breastfeeding at 1 year and at 20 – 23 months Breastfeeding at 1 year and at 20 – 23 months were calculated using the following formulae respectively. Children 12 – 15 months who received breast milk during the previous 24 hours x 100

Children 12– 15 months of age

Children 20 – 23 months who received breast milk during the previous 24 hours x 100 Children 20 – 23 months of age

The validity of these indicators depends upon sufficient sample size in these age groups; there appears to be ample sample in both of these age groups in this baseline survey. Figures 2 and 3 and table 15A show that 85% of children were still breastfed at 12 – 15 months, and 53% at 20 – 23 months, indicating a high proportion of children were breastfed at 1 year and more than half of children were breastfed at the end of the second year. A lower proportion of children were breastfed at 20 – 23 months in the intervention group than control.

Figure 2

Continued breastfeeding at 12 ‐ 15 mby study group

79.587.4 84.5

0102030405060708090

100


Prop

ortion

of children 12

‐15

mon

ths who

are breastfed

Figure 3

Continued breastfeeding at 20 ‐ 23 m by study group

66.0

46.152.9

0102030405060708090

100


Prop

ortion

of children 20

‐23

mon

ths who

are breatfed

d. Introduction of complementary foods. The indicator for the introduction of appropriate complementary foods (solid, semi-solid or soft foods) for children 6 – 8 months was calculated using the following formula. Infants 6 – 8 months who received solid, semi-solid or soft foods in the previous 24 hours x 100

Infants 6 – 8 months Eighty-six percent of infants were reported receiving solid, semi-solid or soft foods at 6 – 8 months of age (Table 17), similar between intervention and control groups. Care needs to be taken to be sure that there is sufficient sample in this narrow age range; however with a total of 199 this should be sufficient for use of this indicator.

Table 17 Proportion of infants who receive solid, semi-solid or soft foods 6 – 8 months

by study group

Control % n

Intervention% n

Total % n

Chi-square p value

Proportion of children 6 – 8 months who received solid, semi-solid or soft foods n

85.1

74

87.2

125

86.4

199

0.681

e. The process of infant feeding practices, breastfeeding and introduction of other liquids and complementary foods by month of age is illustrated in Figures 4 and 5. Figure 4 shows how the proportion of exclusively breastfed infants decreases with age and the increase in consumption of solid, semi-solid or soft foods during the first year. By 6 – 7 months there is almost no EBF as most infants are receiving semi-solid complementary foods.

Figure 4

Age (months 0 1 2 3 4 5 6 7 8 9 10 11 12 EBF 48 44 23 22 13 7 10 0 1 1 2 0 1 Solid, semi-solid or soft foods 0 1 3 9 10 24 51 58 61 53 54 52 54

Figure 5 shows the different feeding patterns and the changes that occur by month of age for the first 2 years

Figure 5

Infant feeding practices by age

0%

20%

40%

60%

80%

100%0‐1

2‐3

4‐5

6‐7

8‐9

10‐11

12‐13

14‐15

16‐17

18‐19

20‐21

22‐23

Age groups in months

Not receiving any breast milk

Breast milk and non-milk liquids

Breast milk and complementary foods

Breastfed and plain water only

Breast milk and other milk/formula

Exclusive breastfed

f. Breastfed infants (6 – 9 months, a 4-month period) with timely introduction of complementary foods An additional, previous indicator is presented in Table 18 showing the introduction of solid, semi-solid or soft foods over a wider period, 6 – 9 months. This earlier indicator includes receiving breastmilk and is calculated using the following formula. Thus, as this is not comparable with the current 6 – 8 month indicator, we present for all children and for those receiving breastmilk in Table 18.

Infants 6 – 9 months who received breast milk and a solid, semi-solid or soft food in the previous day x 100

Infants 6 – 9 months

Table 18 Proportion of infants who receive solid, semi-solid or soft foods 6 – 8 months

by study group.

Control % n

Intervention% n

Total % n

Chi-square p value

Proportion of children 6 – 9 months who received solid, semi-solid or soft foods n

87.9

91

89.0

163

88.6

254

0.802

Proportion of children 6 – 9 months who were breastfed and received solid, semi-solid or soft foods

85.7

78.5

81.1

0.161

g. Minimum dietary diversity Figure 6 and table 16A show the different food groups of the survey instrument consumed by children 6 – 23 months. Food groups consumed (yesterday) by most children were cereals and beans, followed by milk products, fats, and non vitamin A rich fruits and vegetables. Patterns were similar between control and intervention groups except for roots and tubers, vitamin A rich fruits, fats and chocolates/sweets. 32.8% of children (0 – 23 months) were given a feeding bottle, similar between intervention and control groups.

Figure 6

Introduction of complementary foods for IYC 6 – 23 months% of children who consumed the food groups yesterday by study group

0

10

20

30

40

50

60

70

80

90

100

Cereals

Potato, cassava, quequ

isqu

e, malanga

Ayote, platano

maduro, Carrots, pipian

Beans, lentils

Green

leaves

Mango, papaya, bananos

Other fruit o

f vegetable

Chicken liver, organ

meat

Meats

Fish, sea or river food Eggs

Cheese, curd, milk produ

cts

Oil, lard, butter, fats

Chocolates, sweets, cakes, sugary food

s

Infant fo

rmula

Food

fortified

with

iron

%

Control

Intervention

Total

The 14 food groups of the survey were grouped into 7 food groups as defined in the WHO indicators to calculate dietary diversity; table 17A shows the 7 food groups and the corresponding assignation of the survey food groups to each of these. The minimum dietary diversity indicator is the consumption by the infant of 4 or more of the 7 food groups on the previous day and is calculated using the following formula for children 6 – 23 months of age: Children 6 – 23 months who received foods from >4 food groups during the previous day _______________________________________________________________________

Children 6– 23 months of age

As can be seen in the figure 7 and table 18A, half of all children 6 – 23 months met the minimum dietary diversity, with a similar proportion in both study groups.

Figure 7

Minimum dietary diversity: children 6 ‐ 23 m consuming 4 or more food groups, by study group

46.651.6 49.8

010

2030

405060

7080

90100


Prop

ortion

of children 6 ‐ 2

3 mon

ths

Control

Intervention

Total

The minimum dietary diversity data for breastfed and non breastfed children by age group are presented in Figure 8 and tables 19A and 20A in the appendix. For breastfed children 47.2% met this criteria and for non breastfed, 60%, possibly due to more non breastfed children receiving cow’s milk (data not analysed) and so these values between breastfed and not breastfed children should not be directly compared. In the case of breastfed children the proportion of children with minimum dietary diversity increases with age, whereas this does not occur with the non breastfed children, however, as mentioned above, these cannot be directly compared, and in the latter case the small sample in each of the sub age groups should be taken into consideration.

Figure 8

Minimun dietary diversity for breastfed and non breastfed children by study group

45.848.1 47.2

51.0

63.760.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0


Proportion

of children 6 ‐ 23

months

breastfed

non breastfed

h. Minimum meal frequency The minimum meal frequency, number of meals or feeding episodes consumed by the child during the previous day or night, is a proxy for adequate energy intake from complementary foods of the child based on the following minimum times according to age and breastfeeding status. In the case of breastfed children it includes non-liquid foods and for non-breastfed children also includes milk feeds. The minimum feeding frequency definitions are:

- 2 times for breastfed infants 6 – 8 months - 3 times for breastfed infants 9 – 23 months - 4 times for non breastfed infants 6 – 23 months

“Meals” include meals and snacks other than trivial amounts, which we assume is implied in question 18 of the survey instrument. This indicator is calculated from the following 2 fractions:

Breastfed children 6 – 23 months of age who received solid, semi-solid or soft foods the minimum number of times or more during the previous day

Breastfed children 6 – 23 months and

Non-breastfed children 6 – 23 months of age who received solid, semi-solid or soft foods or milk feeds the minimum number of times or more during the previous day

Non-breastfed children 6 – 23 months

As shown in Figure 9 and Table 21A, 71.9% of children 6 – 23 months met the minimum meal frequency, similar between intervention and control groups. This indicates however, that 28.1% of children are not meeting even minimum meal frequency.

Figure 9

Percent of children 6 ‐ 23 months with minimum meal frequency by study group

70.8 72.5 71.9

0

20

40

60

80

100


Prop

ortion

of children 6‐23

mon

ths

Control

Intervention

Total

For breastfed children 68.8% meet the minimum meal frequency (Figure 10). There is a higher proportion of non breastfed children meeting the minimum food frequency (84.0%), probably due to the number of milk feeds that this group receives.

Figure 10

Percent of children 6‐23 months with minimum meal frequency by breastfeeding practice and study group

68.3 69.2 68.8

84.3 83.9 84.0

0.010.020.030.040.050.060.070.080.090.0

100.0


Prop

ortion

of children

breastfed

non breastfed

The proportion of children meeting minimum meal frequency is presented by sub age groups and shown in Tables 22A and 23A in the Appendix. For breastfed children there is

an increase with age group, and similar between intervention and control; for the non breast fed children this increase is not observed. Table 19 shows the mean number of feeding frequency of solid, semi-solid and soft foods during the previous day and night for breastfed children and the number of feeding frequency of solid, semi-solid and soft foods for non breastfed children. In the case of breastfed children this ranges from 2.2 to 3 times according to age and for non breastfed from 2.3 to 3.2 with increasing age and similar between intervention and control communities.

Table 19 Mean (sd) and median meal frequency by age group, breastfeeding practice and

study group, for children 6 – 23 months (for all children including those who had 0 meals)

Age

group (months)


Total

mean + sd

n

median mean + sd

n

median mean + sd

n

median

Breastfed children 6 - 8 2.3

+1.23 73

3.0 2.2 +1.43 107

2.0 2.3 +1.35 180

2.0

9 - 11 2.6 +1.33

52

3.0 2.6 +1.24

97

3.0 2.6 +1.27 149

3.0

12 - 23 2.9 +1.36 146

3.0 3.0 +1.11 224

3.0 3.0 +1.21 370

3.0

Non breastfed children 6 – 8

n 2.0

1

2.0 2.3 +1.74

18

2.0 2.3 +1.70

19

2.0

9 - 11 2.5 +1.73

4

2.0 2.7 +1.16

12

3.0 2.6 +1.26

16

2.5

12 - 23 3.0 +1.29

46

3.0 3.3 +1.22

94

3.0 3.2 +1.24 140

3.0

i. Minimum acceptable diet The minimum acceptable diet is a composite indicator which includes both minimum feeding frequency and minimum dietary diversity, thus giving an approximation of energy intake and dietary quality. The WHO indicator is calculated from the following 2 fractions:

Breastfed children 6 – 23 months of age who had at least the minimum diversity and the minimum meal frequency during the previous day

Breastfed children 6 – 23 months and

Non-breastfed children 6 – 23 months of age who received at least 2 milk feedings and had at least the minimum diversity not including milk feeds and the minimum meal frequency during the

previous day Non-breastfed children 6 – 23 months

As number of milk feeds is included in the minimum meal frequency for non breast fed children, milk is excluded from the 4 groups for diversity score in this indicator so as not to overestimate with the presence of milk. Figure 11 and Table 24A show that only 34.9% of all children 6 – 23 months of age meet the criteria for a minimum acceptable diet in this population, similar in intervention and control groups. Only 38.1% of breastfed children and 22.3% of non breastfed children met this criterion as shown in Figure 12. It is lower in non breastfed children probably because milk and milk products group is excluded from contributing to the diversity score in this case as it is included as number of milk feeds. The proportion of children increases with age for breastfed children (Table 25A), with a significantly higher proportion in the intervention group for the 12 – 17 month group, but this tendency is not seen with the non breastfed children (Table 26A).

Figure 11

Percent of children 6 ‐ 23 months with minimum acceptable diet by study group

32.9 36.1 34.9

0

20

40

60

80

100


Prop

ortion

of children

Control

Intervention

Total

Figure 12

Percent of children 6‐23 months with minimum acceptable diet by breastfeeding practice and study group

36.2 39.3 38.1

15.725.0 22.3

0.010.020.030.040.050.060.070.080.090.0

100.0


Prop

ortion

of children

breastfed

non breastfed

j. Consumption of iron-rich or iron-fortified foods This indicator is a composite indicator that reflects the presence of iron containing foods in the child’s diet. It includes both iron-rich foods (new food group assignation 1) and/or the presence of an iron fortified food or foods fortified in the home (e.g. sprinkles). It is calculated using the following formula:

Children 6 – 23 months of age who received an iron-rich food or a food that was specially designed for infants and young children and was fortified with iron, or

a food that was fortified in the home with a product that included iron during the previous day Children 6 – 23 months

Only 35.4% of children 6 – 23 months consumed an iron rich of iron fortified the previous day increasing slightly with age and similar between control and intervention groups as shown in Figures 13 and 14 and Table 27A.

Figure 13

Percent of children 6 ‐ 23 months consuming iron‐rich or iron fortified foods by age and study groups

0

10

20

30

40

50

60

70

80

90

100


%6‐23 months

6‐11 months

12‐17 months

18‐23 months

C

This indicator is disaggregated for the proportion of children who consumed iron rich (food group assignation 1) or iron fortified foods by age group (Figure 14 and Table 28A). The mean proportion of children receiving food from the meat group ranged from 12 – 27% according to age, with significant differences between control and intervention group for age groups 6 – 11 and 18 – 23 months. The mean proportion of children who received fortified foods ranged from 18 – 30% with a significant difference between control and intervention groups for the oldest age group.

Figure 14

Percent of children 6‐23 mo consuming iron‐rich or iron fortified foods, by type of food and study group

34.5

16.523.6

35.4

17.623.3

35.9

18.323.2

0

10

20

30

40

50

60

70

80

90

100

iron‐rich orfortified foods

meats fortified foods

% Control

Intervention

Total

k. Bottle feeding: The indicator of proportion of children 0 – 23 months who are fed with a bottle was calculated using the following formula:

Children 0 – 23 months who were fed with a bottle during the previous day Children 0– 23 months of age

Around one third of the population (32.8%) was fed using a feeding bottle in this population, similar between control and intervention groups as shown in Table 20. 21.6% of infants 0 – 6 months were given a bottle and this increased to around 36% 6 - 23 months.

Table 20

Proportion of children 0 – 23 months who were fed with a feeding bottle, by age and study groups

Control

% n

Intervention% n

Total % n

Chi-square p value

Proportion of children 0 – 23 months who were fed with a feeding bottle

31.2

430

33.8

722

32.8

1152

0.357


21.3

108

21.8

170

21.6

278

0.926

Proportion of children 6 - 11 months who were fed with a feeding bottle

36.2

130

35.5

234

35.7

364

0.896


33.3

192

39.0

318

36.9

510

0.199

Prevalence of diarrhoea with use of a feeding bottle was explored in this population. Table 21 shows that there is no association between the use of the feeding bottle and diarrhoea prevalence in this population. However this analysis is on all children, not only infants under 6 months or 1 year.

Table 21 Use of feeding bottle and prevalence of diarrhoea

Children with diarrhoea in previous 2 weeks Control

% n

Intervention % n

Total % n

Used feeding bottle 31.6 55

37.2 107

35.1 162

Did not use feeding bottle

68.4 119

62.8 181

64.9 300

Section 05 of survey instrument: Maternal and child care. Table 22 gives the results for prenatal attention that the mothers received. Eighty-eight percent of mothers had at least one prenatal check up, mostly done by a doctor and/or nurse. These mothers had a mean of 4.4 check ups during their pregnancy with a range of 1 – 9. The results are similar between control and intervention groups with the exception of who did the prenatal check ups. Distance was a predominant reason for not having a check up amongst those few who did not.

Table 22

Maternal and child health care Prenatal attention

Control

%

Intervention%

Total %

Chi-square p value

n 430 722 1152 % Mothers who had prenatal checks 87.0 88.6 88.0 0.400 Who did the check ups %:

• Doctor • Nurse • Doctor and nurse • Don’t know (DK)

41.0 44.1 14.4 0.5

39.4 32.9 27.0 0.6

40.0 37.1 22.4 0.6

0.000*ª

Number of check ups (for those who had check ups)

• Mean • Sd • Median • (Range) • n

4.33 2.07 4.0

300

4.5 2.11 4.0

558

4.4 2.10 4.0

(1 - 9) 858

0.247 (Anova)

Reason for not having check ups (multiple responses), % of mothers who mentioned:

• Transport cost • Distance • Husband did not give

permission • Ill treatment by personnel • Not considered necessary • Other

DK

1.4 7.2 0.0

0.7 3.3 2.8 0.7

1.7 4.6 0.1

0.8 2.9 3.2 0.6

1.6 5.6 0.1

0.8 3.0 3.0 0.6

p value

0.724 0.059 1.000ª

1.000ª 0.740 0.706 1.000ª

ª = with Yates correction Seventy percent of mothers received dietary recommendations at their prenatal check up, similar in both control and intervention groups (Table 23); breastfeeding and infant feeding were the topics received most mentioned by the mothers. 55% of mothers reported receiving information about infant feeding from other people during their pregnancy, more in the intervention than the control group. This was more frequently from “brigadistas”, followed by relatives, with differences in these between control and intervention groups.

A high proportion of mothers reported receiving (82%) and of these, taking (99%) iron supplements during pregnancy, similar between control and intervention groups.

Table 23 Maternal and child health care

Dietary information/supplements received by mothers during pregnancy Control Intervention Total Chi

square p value

% Mothers who received dietary recommendations at check ups

69.7

72.3

71.3

0.392

Dietary advice given about following topics: % mothers who mentioned:

• Breast feeding • Feeding of infant • Danger signs in children • Danger signs for pregnancy

and birth complications • Other • DK

31.2 38.1 0.9 3.3

14.7 1.9

34.3 45.6 1.2 4.4

11.9 1.1

33.2 42.8 1.1 4.0

12.9 1.4

0.267 0.014* 0.829ª 0.324

0.180 0.291

% Mothers who received information about breastfeeding/infant feeding from others during pregnancy

46.2 60.6 55.3 0.000*

Other person who spoke about breastfeeding/infant feeding during pregnancy: % mothers

• Relatives • “Brigadistas” • Midwife • Other

10.2 19.5 3.3 4.0

14.4 28.5 3.5 4.8

12.8 25.2 3.4 4.5

0.041* 0.001* 0.851 0.480

% Mothers who received iron tablets during pregnancy n

80.2

430

82.3

719

81.5

1149

0.374

Of mothers who received, % mothers who consumed iron tablets during pregnancy

98.3 98.6 98.5 0.637

About half (52%) of mothers had an institutional birth and 48% a home birth (Table 24). Forty-seven percent of mothers reported that a doctor attended at the birth of their infant, followed by a midwife (28%, nurse (23%) and husband or relative (19%). This was similar between control and intervention groups except in the case of the nurse. The most common reason for not being attended by a doctor or nurse was that the baby came prematurely, followed by distance (12%) or that they did not consider it necessary (9.6%). For this latter reason there was a difference between control and intervention groups. Seventy- eight percent of mothers reported receiving support for their breastfeeding or infant feeding, mostly from their own mother, followed by relatives, husband and then

mother in law. The most common type of support received was help with the housework (612%). Table 24. Maternal and child health care: Attention during birth and breastfeeding Control

%

Intervention%

Total %

Chi-square

p value Who attended mother during birth, % mothers:

• Nurse • Doctor • Husband/relative • Midwife • Other • DK

20.0 46.7 20.0 25.8 2.1 0.2

24.7 47.5 18.8 29.9 1.7 0.3

22.9 47.2 19.3 28.4 1.8 0.3

0.069 0.802 0.628 0.135 0.597 1.000ª

Who attended mother during birth, % (aggregated)

• Institutional (doctor, nurse) • Home (husband/relative,

midwife, other)

52.7 47.3

51.6 48.4

52.0 48.0

0.723

Reason for not being attended by doctor or nurse (multiple responses), % of mothers who mentioned:

• Transport/food cost • Distance • Ill treatment by personnel • Not considered necessary • Baby came prematurely • Other • DK

4.4 11.4 0.7 12.3 14.9 12.6 4.4

4.4 12.3 0.6 8.0 18.7 10.5 4.2

4.4 12.0 0.6 9.6 17.3 11.3 4.3

0.991 0.638 1.000ª 0.017* 0.098 0.292 0.834

% Mothers who received support for breastfeeding/feeding infant

77.2 78.4 78.0 0.625

Who gave support: % • Husband • Mother • Mother in law • Other relatives • Others • DK

14.2 29.1 11.9 22.3 9.8 0.2

16.8 32.3 13.4 23.5 10.0 0.1

15.8 31.1 12.8 23.1 9.9 0.2

0.247 0.256 0.440 0.635 0.910 0.711

Type of support received, % mothers • Help with the housework • Stopped work/reduced work • Help with breastfeeding after

birth • Help with breastfeeding first 6

months • Help with feeding child • Other • DK

60.7 8.8 15.1 4.4

13.0 13.0

0

62.6 23.1 16.9 3.2

12.2 17.0

0

61.9 17.8 16.2 3.6

12.5 15.5

0

0.519 0.000 0.428 0.280

0.679 0.069

Child health care is presented in Table 25. The majority of infants were vaccinated in the first 6 weeks (84%) and in the last 6 months (79%); in this latter variable there is a difference between control and intervention groups. A high proportion of children had diarrhoea in the past 2 weeks (40%). Food was continued to be given to the child during the episode of diarrhoea in 2/3 of the population, either the same as normal (33%) or less than normal (34%); but 32% did not give food during the episode. Approximately similar proportions reported giving or not giving liquids during the diarrhoea. Fifty-three percent of children were reported to have cough in the past 2 weeks and a high proportion of these with rapid or difficulty with breathing. The proportion of children who continued to be fed the same as normal was 35%, or less than normal, 31%, during the cough episode, and 31% were reported to not be fed with cough. Seventy-three percent of children were reported to have growth monitoring check ups, being lower in control than in the intervention group. The mean number of checkups reported was 3.8, with a range of 0 – 15 check ups. This will obviously be related to the age of the child at the time of the survey.

Table 25 Child health care

Control

% Intervention

% Total

% Chi-square

p value

% Infants vaccinated in first 6 weeks after birth

83.5 84.5 84.1 0.661

% Children vaccinated in the last 6 months

76.0 81.4 79.4 0.030*

% Children with diarrhea in last 2 weeks

40.5 39.9 40.1 0.847

Gave breastmilk to child during diarrhea: % Yes, same as normal Yes, less than normal Yes, more than normal No n

57.5 21.8 6.3 14.4 174

58.7 13.2 6.9 21.2 288

58.2 16.5 6.7 18.6 462

0.052

Gave food to child during diarrhea: % Yes, same as normal Yes, less than normal Yes, more than normal No

30.6 30.1 2.3 37.0

34.4 35.8 1.4 28.5

33.0 33.6 1.7 31.7

0.211

Gave liquids to child during diarrhea: % Yes, same as normal Yes, less than normal Yes, more than normal No DK

35.6 27.0 7.5 29.9

0

35.1 29.2 4.5 30.9 0.3

35.3 28.4 5.6 30.5 0.2

0.642

% Children with cough in last 2 weeks

52.3 53.0 52.8 0.812

% Children with cough who breathed more rapidly/ agitated/ difficulty in breathing

71.9 72.3 72.1 0.921

% Gave breastmilk to children with cough: % Yes, same as normal Yes, less than normal Yes, more than normal No

58.0 20.1 7.6 14.3

54.7 17.3 7.1 20.9

55.9 18.3 7.3 18.5

0.228

% Gave food to children with cough: % Yes, same as normal Yes, less than normal Yes, more than normal No

34.7 30.2 1.3 33.8

35.0 32.1 1.6 31.3

34.9 31.4 1.5 32.2

0.923

% Gave liquids to children with cough: % Yes, same as normal Yes, less than normal Yes, more than normal No

28.9 26.2 4.0 40.9

35.9 28.3 3.7 32.2

33.3 27.5 3.8 35.4

0.148

% Children with growth monitoring checks

69.3 75.3 73.1 0.025*

Number of growth monitoring checks

• Mean • Sd • Median • Range

3.8 3.03 3.0

(0-15)

3.7 2.83 3.0

(1-15)

3.8 2.90 3.0

(1 – 15)

0.570 (Anova)

Section 06 of the survey instrument: Knowledge and information The most common source of information regarding child feeding was health personnel (Table 26); Brigadistas/ midwives, health personnel were most frequently mentioned by the mothers as having talked to them about child feeding (around 32% in each case).The mother’s own mother was the next most frequently mentioned (20%). There was a significant difference in the frequency with which the mother’s mother and the husband were mentioned between control and intervention groups. How to feed the child was the topic talked about most mentioned by the mothers (40%) followed by types of food to give the child and the recommendation to exclusively breastfeed for the first 6 months. There was a significant difference between control and intervention groups regarding the topics related to giving BM immediately after birth and feeding the child during illness, in both cases more frequently mentioned in the intervention group. Mothers reported that the source they most trusted for feeding advice was health personnel (42%) followed by brigadistas /midwives and then the mother’s own

mother. There was a difference in the latter between control and intervention groups. The results were very similar for whose recommendation the mother follows. Mothers reported the most frequent source for hearing or seeing information about feeding or caring for their child was the radio (66%) followed by the health centre. Differences are observed for the health centre and the church between control and intervention group.

Table 26 Maternal knowledge and information

(multiple answers, mothers could report more than one)

Control %

Intervention%

Total %

p value

Who has talked with mother about feeding child: %

• Husband • Mother • Mother in law • Other relatives • “Brigadistas”, midwives • Health personnel • Others • Nobody

1.6 14.2 7.0 5.6 31.4 34.2 3.0 33.0

4.0 23.3 7.9 6.8 32.5 32.1 4.3 28.7

3.1 19.9 7.6 6.3 32.1 32.9 3.8 30.3

0.024* 0.000* 0.568 0.417 0.685 0.473 0.277 0.120

What did they talk about? % of mothers mentioned:

- Give EBM for 6 months - Give BM immediately after

birth - How to breastfeed (frequency,

position, other) - How to feed child (frequency,

consistency) - Types of food/meals for child - How to feed child during

illness - Other

27.2 6.0

3.7

40.9

30.7 9.3

8.6

30.6 14.4

4.6

39.5

32.1 17.0

9.1

29.3 11.3

4.3

40.0

31.6 14.1

8.9

0.220 0.000*

0.489

0.626

0.612 0.000*

0.758

Who mother most trusts for feeding advice: % mothers mentioned:


4.4 21.4 6.7 6.7 30.7 43.7 3.7 12.1

5.1 26.9 7.5 5.0 29.9 40.6 3.9 9.8

4.9 24.8 7.2 5.6 30.2 41.8 3.8 10.7

0.590 0.037* 0.641 0.211 0.780 0.296 0.893 0.230

Whose recommendation does mother follow: % mothers mentioned:


5.6 20.9 5.6 4.4 27.4 44.7 3.0 10.5

5.8 26.7 7.1 3.3 28.3 39.6 2.1 9.6

5.7 24.6 6.5 3.7 28.0 41.5 2.4 9.9

0.868 0.027* 0.324 0.343 0.766 0.093 0.313 0.618

Where has mother heard or seen information about feeding or caring for her child: % mothers mentioned:

• Radio • Health centre • Newspaper • Poster/advertisement • Ferias/fairs • Church • Other • Nowhere

63.7 31.2 0.2 5.6 0.7 2.8 8.6 19.5

67.5 37.8 0.4 7.9 0.7 6.0 8.9 15.7

66.1 35.3 0.3 7.0 0.7 4.8 8.8 17.1

0.196 0.022* 1.000ª 0.137 0.992 0.015* 0.880 0.090

a=Yates’correction Section 07 of the Surrey instrument: Maternal nutrition Dietary Diversity The frequency of consuming different food groups by the mothers in control and intervention groups during the previous day and night is shown in Table 27. It can be seen that the cereals and beans groups are those that are most consumed by almost all of the mothers, followed by milk products, fats, non vitamin A rich fruits or vegetables, sweets, iron fortified food, eggs and meats. There is no difference between intervention and control groups.

Table 27 Food group consumption by mothers in control and intervention groups

Control

% Intervention

% Total

% n 430 722 1152 Cereals 98.4 98.3 98.4 Potato, cassava, quequisque, malanga

11.4 15.1 13.7

Ayote, platano maduro, Carrots, pipian

19.8 16.5 17.7

Beans, lentils 89.8 88.6 89.1 Green leaves 1.4 1.0 1.1 Mango, papaya, bananos 14.4 25.1 21.1 Other fruit or vegetable 47.0 49.7 48.7 Chicken liver, organ meat 1.6 0.7 1.0 Meats 25.6 21.7 23.2 Fish, sea or river food 1.2 0.8 1.0 Eggs 23.0 31.6 28.4 Cheese, curd, milk products 60.5 60.5 60.5 Oil, lard, butter, fats 51.4 60.4 57.0 Chocolates, sweets, cakes, sugary foods

37.4 43.9 41.5

For the purpose of exploring maternal dietary diversity we have grouped the foods into 9 food groups. This is based on recent work by FANTA, IFPRI and others who have been exploring indicators for maternal dietary quality through the analyses of different data sets of dietary intakes of various developing countries and have found a relationship between number of these food groups and mean micronutrient adequacy (MMA) (M Arimond et al. 2009). These authors have explored indicators using 9, 11, 13 and 21 food groups and we have used the 9 food grouping for this exploration as listed below as this most lends to the food group data in this survey. It is important to note that these food groups reflect micronutrient intakes and so do not include the food groups of fats or sweets and sugar. The 9 food groups for analysis (letters show the grouping of the food groups listed in the questionnaire) are the following:

- All starchy staples: aa, bb - All Legumes and nuts: dd - All dairy: ll - Organ meat: hh - Eggs: kk - Other animal source foods: ii, jj - Dark green leafy vegetables: ee - Other vitamin A-rich fruits and vegetables: cc, ff - Other fruits and vegetables: gg

Tables 28 and 29 show the frequency of number of food groups (of the total of 9 for MMA) and the mean and median number of these food groups consumed by the mothers

in the study. The mean number of food groups consumed is 4 and the distribution is similar between control and intervention groups.

Table 28 Proportion of mothers by number of food groups consumed, by study group.

Number of food groups consumed

Control %

mothers

Intervention %

mothers

Total %

mothers 0 0 0.1 0.1 1 1.4 0.7 1.0 2 14.2 12.6 13.2 3 28.6 26.7 27.4 4 27.9 29.6 29.0 5 17.0 19.4 18.5 6 8.8 7.9 8.2 7 2.1 2.9 2.6 8 0 0 0 9 0 0 0

Table 29

Mean number of food groups consumed by mothers


Total

mean + sd

median mean + sd

median mean + sd

median

3.8 1.29

4.0 3.9 1.27

4.0 3.9 1.28

4.0

Due to the practice of maternal dietary restriction during the first month after birth the number of food groups consumed by mothers with infants in this age group is compared to all other mothers. Table 30 shows that in fact mothers with babies under 1 month receive a significantly lower number of food groups than the other mothers, showing that dietary diversity is less during this period.

Table 30 Mean number of food groups consumed by mothers with an infant less than 1 month

compared to those with infants 1 – 23 months. Number of food groups consumed mean

+ sd median

Mothers with infant <1month n=56

2.7 + 0.89

3.0

Mothers with child >1 month n=1096

3.9 + 1.27

4.0

p=0.000

In the analyses by Arimond et al. 2009, statistical relationships with MMA were found to be strongest with cut off points of 4 or 5 of the above 9 food groups. Thus we present the proportion of mothers in this study that consume 4 or more and 5 or more of these food groups using the following formula. Mothers who received foods from >4 (or 5) food groups during the previous day x 100 ______________________________________________________________________

Mothers

Table 31 Proportion of mothers who consumed 4 or more and 5 or more of the food groups by

study group Control

% n

Intervention % n

Total % n

Proportion of mothers who consumed 4 or more of the 9 food groups n

55.8

430

59.8

722

58.3

1152 Proportion of mothers who consumed 5 or more of the 9 food groups

27.9 30.2 29.3

It is important to note that this is an exploratory indicator of maternal dietary diversity and thus no conclusions can be drawn. Yet it is interesting that only 58% of the mothers meet the 4 or more food group intake and 30% of mothers consume 5 or more food groups (Table 31). Nevertheless these indicators can be used to compare maternal dietary diversity before and after the intervention. On the suggestion of Mary Arimond (personal communication) we have calculated 2 further indicators: i) a score for the total number of animal products groups (hh, ii, jj, kk, ll including milk, giving a maximum total score of 5) and ii) a score for the total number of vegetable and fruits groups (ee, ff, gg, cc, giving a maximum score of 4). Table 32 shows that the mean scores amongst mothers in this population is low with a median of only 1 food group out of a possible 5 for animal products and similarly 1 out of 4 for possible vegetable products. This is the same for both intervention and control groups.

Table 32 Mean dietary scores for animal products and fruits and vegetables food groups.

Control Intervention Total Mann-

Witney mean

+ sd median mean

+ sd median mean

+ sd median

Animal products score

1.12 + 0.83

1.00 1.15 + 0.86

1.00 1.14 + 0.85

1.00 0.637

Vegetables and fruits score

0.83 + 0.74

1.00 0.92 + 0.84

1.00 0.89 + 0.81

1.00 0,134

Consumption of an iron fortified food by mothers

The following formula was used to calculate the proportion of mothers who consumed a food fortified with iron.

Mothers who consumed a food fortified with iron during the previous day x 100 Mothers

Table 33

Proportion of mothers who consumed a fortified food % Mothers who consumed: Control

% Intervention

% Total

% Food fortified with iron 26.3 31.9 29.8 The fortified food(s) is unknown as this was not explored in the survey but it/they were consumed by 30% of mothers (Table 33). Consumption of iron rich food or iron fortified food by mothers The following formula was used to calculate the proportion of mothers who consumed an iron rich food, which included liver, offal, meats and fish and sea or river food or an iron fortified food.

Mothers who received an iron-rich food (hh, ii, jj) or a food fortified with iron during the previous day

Mothers

Table 34 Proportion of mothers who consumed an iron rich food or fortified food

Control

% n

Intervention % n

Total % N

Proportion of mothers who consumed an iron rich food or iron fortified food

45.6 44.9 45.1

Nearly half of the population of mothers (45%) consumed and iron rich food or iron fortified food, the same proportion in control and intervention groups as shown in table 34. DISCUSSION The objective of this survey is to provide cross-sectional baseline data of IYC and maternal feeding indicators, IYC nutritional status and health practices to design and be able to evaluate the education interventions to improve infant and maternal feeding practices and nutritional status of the IYC in these Nicaraguan communities. The base-line data provides information on current practices which allows the selection and design of the intervention content and serves as comparison with a final evaluation using similar criteria. This baseline data also serves to describe these conditions in the control

population to assure that it is comparable with those who will receive the intervention and allows the evaluation of changes that can be attributed to the intervention. The population characteristics described in this baseline survey are similar between intervention and control communities. The nutritional status data of these populations show growth patterns typical of many developing countries, especially in Latin America (LA). Height-for age Z-scores and prevalence of stunting is low at 0 – 6 months but rapidly increases to 30% during the second year using the WHO reference standards. This is a high prevalence, higher than the national average for Nicaragua, and higher than several countries of LA, although less than other Central American countries such as rural Guatemala. When the NCHS standards are used, prevalence of stunting and other under nutrition indicators are lower, as found in other countries, due to the different growth patterns between predominantly breastfed and formula fed children. Although most countries have adopted the new WHO 2006 reference standard, both standards are frequently used for purposes of comparison with information from previous years and because reported national prevalence of stunting is lower with the NCHS standards. For the majority of the anthropometric variables and prevalences of under- nutrition there are similarities between control and intervention populations, indicating that this is a comparable population for nutritional status. The prevalence of overweight and obesity is low in this population using either reference standards, similar between intervention and control groups and tends to decrease with age. Most of the infant feeding practices described are similar between intervention and control groups, indicating that these are comparable populations. Early infant feeding practices show that the majority of infants breastfeed and 75% within the first hour. However the introduction of liquids during the first 3 days is not uncommon. These are practices that need to be addressed in the intervention. Exclusive breastfeeding dropped from 80% in the first month to 26% 4 – 5 months with introduction of cow’s milk, fresco and waters during this time. This level of exclusive breastfeeding is low and needs to be addressed in the intervention. The process of introduction of complementary foods is similar between intervention and control groups. Foods are timely introduced according to the indicator 6 – 8 months but the quality of the complementary food given is inadequate as shown by the low dietary diversity; only half of the children met the minimum dietary diversity. More children met the minimum feeding frequency requirement but only 35% met the minimum acceptable diet, thus both feeding frequency and a more diverse diet need to be addressed in the intervention. Iron intake is low in the Nicaraguan population (Mora 2007) and sources of iron in the diet need to be addressed. The proportion of children consuming iron rich foods is low, only 18% consumed a meat product and 23% an iron fortified foods. Ways to increase iron rich foods need to be addressed in the intervention. Health care and child health indicators were mostly similar between intervention and control groups. Prevalence of diarrhoea and cough are high amongst the children and feeding during illness needs to be addressed in the intervention. Attendance for growth monitoring sessions needs to be encouraged. Mothers receive information about child feeding from a variety of sources; thus consistency in messages needs to be addressed in

the intervention with especial attention to health personnel who are important credible sources of advice. Dietary diversity of the mothers’ diet is low and especially for animal sources (median score 1/5) and vegetable and fruits (median score 1/4). This is especially low during the first month after giving birth. However, the dietary diversity of the mothers may be higher than with the children although different criteria for calculation of these are used (9 food groups for the mothers, 7 food groups for the children). Strategies to increase dietary diversity in both mothers and children need to be sought for the intervention. REFERENCES Arimond M. et al. 2009. Simple indicators of dietary diversity are associated with micronutrient adequacy for women of reproductive age in resource-poor settings. EB 2009 Encuesta Nicaraguense de demografía y salud ENDESA 2006/7. Informe preliminar. Instituto Nacional de información de desarrollo programa MECOVI. Análisis de la situación de menores de 5 años en el 2005 y análisis de tendencias de desnutrición 1998-2001-2005. Nicaragua. Marini et al. 2009 Promoción del crecimiento para prevención de la desnutrición crónica. Estrategia con base comunitaria en Central America. Banco Mundial. Jose O. Mora 2007 Integrated Anemia Control Strategy has significantly reduced anemia in women and children in Nicaragua NCHS reference standard USAID 2006. Infant and young child feeding update WHO et al. 2008Indicators for assessing infant and young child feeding practices. Part 1: Definitions. WHO. Indicators for assessing infant and young child feeding practices.Part 2: Measurement. In press. WHO Anthro 3.01 April 2009

APPENDICES

Table 1A Age of the informant

Control Intervention Total n Mean

+ sd Median Range n Mean

+ sd Median Range n Mean

+ sd Median Range

Mother 425 25.5 + 6.9

25 14-44 715 25.1 +6.7

24 14-58 1140 25.3 +

24 14-58

Father 0 2 34.5 +0.7

34.5 34-35 2 34.5 +0.7

34.5 34-35

Grandmother 5 46.8 +15.8

42 35-74 5 48.8 +6.8

48 40-57 10 47.8 +11.5

45.5 35-74

Total 430 25.7 +7.4

25 14-74 722 25.3 +7.0

24 14-58 1152 25.5 +7.2

24 14-74

Table 2A Ranges for acceptable valid data for NCHS and WHO 2006 reference standards

Children with values outside of these ranges were excluded from the anthropometry analysis.

Z score ranges NCHS Z score ranges WHO (2006) WHZ -4 - +6 WHZ -5 - +5 WAZ -6 - +6 WAZ -6 - +5 HAZ -6 - +6 HAZ -6 - +6 BAZ - BAZ -5 - +5

Table 3A

Length for age Z-score (HAZ) by age and study groups WHO 2006

Age group

(months)


Total Difference between C & I p value

n 426 711 1137 mean

+ sd median mean

+ sd median mean

+ sd median

0 – 5.9 n

-0.38 + 1.13

104

-0.42 -0.37 + 1.08

165

-0.33 -0.38 + 1.10

269

-0.38

0.939

6 – 11.9 n

-0.75 + 1.38

130

-0.89 -0.81 + 1.51

233

-0.91 -0.79 + 1.46

363

-0.91 0.707

12 – 23.9 n

-1.42 + 1.36

192

-1.35

-1.47 + 1.22

313

-1.38 -1.45 + 1.27

505

-1.37 0.650

Table 4A Weight for age Z-score (WAZ) by age and study groups

WHO 2006 Age

group (months)


Total Difference between

C & I p value

mean + sd

median mean + sd

median mean + sd

median

0 – 5.9 -0.37 + 0.95

-0.39 -0.11 + 1.12

-0.12 -0.21 + 1.06

-0.22

0.047*

6 – 11.9 -0.36 + 1.26

-0.29 -0.21 + 1.14

-0.16 -0.27 + 1.18

-0.23 0.246

12 – 23.9 -0.52 + 1.15

-0.47 -0.58 + 1.05

-0.57 -0.56 + 1.10

-0.55 0.503

Table 5A

Weight for Length Z-score (WHZ) by age and study groups WHO 2006

Age group

(months)



C & I p value

mean + sd

median mean + sd

median mean + sd

median

0 – 5.9 -0.08 + 1.10

-0.08 0.24 + 1.33

0.25 0.11 + 1.25

0.12 0.044*

6 – 11.9 -0.14 + 1.31

0.25 0.40 + 1.04

0.42 0.30 + 1.15

0.34 0.038*

12 – 23.9 0.23 + 1.10

0.25 0.18 + 1.05

0.22 0.20 + 1.07

0.23 0.579

Table 6A Length for age Z-score (HAZ) by age and study groups

NCHS Age

group (months



C & I p value

mean + sd

median mean + sd

median mean + sd

median

0 – 5.9 -0.25 + 0.90

-0.30 -0.26 + 0.88

-0.24 -0.25 + 0.89

-0.27

0.915

6 – 11.9 -0.77 + 1.19

-0.86 -0.82 + 1.31

-0.90 -0.80 + 1.26

-0.89 0.733

12 – 23.9

-1.36 + 1.24

-1.32 -1.40 + 1.11

-1.36 -1.39 + 1.16

-1.34 0.675

Table 7A Weight for age Z-score (WAZ) by age and study groups

NCHS Age

group (months



C & I p value

mean + sd

median mean + sd

median mean + sd

median

0 – 5.9 0.08 + 0.81

0.06 0.31 + 1.08

0.24 0.22 + 0.99

-0.14

0.063

6 – 11.9 -0.55 + 1.21

-0.53 -0.41 + 1.16

-0.41 -0.46 + 1.18

-0.45 0.282

12 – 23.9

-0.93 + 1.14

-0.99 -1.00 + 1.03

-1.08 -0.97 + 1.07

-1.05 0.430

Table 8A Weight for Length Z-score /WHZ) by age and study groups

NCHS Age

group (months



C & I p value

mean + sd

median mean + sd

median mean + sd

median

0 – 5.9 0.28 + 0.87

0.27 0.55 + 1.12

0.48 0.45 + 1.04

0.41 0.033*

6 – 11.9 0.08 + 1.19

0.17 0.32 + 1.04

0.25 0.23 + 1.10

0.23 0.048*

12 – 23.9

-0.14 + 1.09

-0.24 -0.21 + 1.03

-0.24 -0.19 + 1.05

-0.24 0.477

Table 9A Overweight and obesity WHZ, by age and study groups

WHO 2006 Age WHZ Control Intervention Total Chi-

square < 6m 0.099 1 – 2 possible risk

overweight 11.5 17.0 14.9

2.01– 3 overweight 1.9 7.9 5.6 >3, obese 0 1.8 1.1 6 – 12m 0.044* 1 – 2 possible risk


2.01– 3 overweight 3.8 3.0 3.3 >3, obese 0.8 1.7 1.4 12 – 24m 0.204 1 – 2 possible risk


2.01– 3 overweight 5.2 1.9 3.2 >3, obese 0 0.6 0.4

Table 10A Overweight and obesity BMI for age, children 0 - 23 months by age and study

groups. WHO 2006

Age BMI for age Control Intervention Total Chi-square

< 6 m 0.025* 1 – 2 possible

risk overweight 6.7 13.3 10.8


1.0 7.9 5.2

>3, obese 0 1.8 1.1 6 – 12m 0.097 1 – 2 possible



3.8 4.3 4.1

>3, obese 0.8 1.3 1.1 12 – 24m 0.152 1 – 2 possible



8.3 3.2 5.2

>3, obese 0.5 0.6 0.6

Table 11A Overweight and obesity BMI for age, children 0 - 23 months by age and study

groups. NCHS

Age WHZ Control Intervention Total Chi-square Less than 6 m

0.066


17.3 20.6 19.3


1.9 8.5 5.9

>3, obese 0 1.8 1.1 6 – 12m 0.409 1 – 2

possible risk overweight

15.4 14.6 14.9


3.1 4.7 4.1

>3, obese 0.8 1.7 1.4 12 – 24m 0.502 1 – 2

possible risk overweight

10.9 8.9 9.7


3.1 1.3 2.0

>3, obese 0 0.3 0.2

Table 12A Proportion of overweight infants (BMI) according to breastfeeding practice for

infants 0 – 6 months. WHO 2006 BMI for age % of infants exclusively

breastfed that are at risk, overweight or obese

(Total n=148)

% of infants that are not exclusively breastfed that are at risk, overweight or

obese (Total n=121)


10.1 11.6

2.01– 3 overweight 4.7 5.8 >3, obese 1.4 0.8

Table 13A Proportion of overweight infants (BMI for age) according to breastfeeding practice

for children 12 – 15 months. WHO 2006 BMI % of children

breastfeeding 12-15 months that are at risk,

overweight or obese (Total n=168)

% of infants not breastfed 12 – 15 months

that are at risk, overweight or obese

(Total n=30)


23.2 33.3

2.01– 3 overweight 1.8 6.7 >3, obese 0.6 0

Table 14A Exclusive breastfeeding indicators of infants 0 – 5.9 months by age and study groups

Control % n

Intervention % n

Total % n

Chi-square p value

Proportion of infants 0 – 5 months exclusively breastfed n

60.2

108

54.1

170

56.5

278

0.320

Proportion of infants 0 – 1 month exclusively breastfed n

78.6

42

81.9

72

80.7

114

0.660


53.8

39

51.1

47

52.3

86

0.797


40.7

27

17.6

51

25.6

78

0.026*


66.7

81

69.7

119

68.5

200

0.645

Table 15A

Continued breastfeeding indicators by age and study group Control

% n

Intervention % n

Total % n

Chi-square p value

Proportion of children 12 – 15 months who are breastfed N

79.5

73

87.4

127

84.5

200

0.135

Proportion of children 20 – 23 months who are breastfed N

66.0

47

46.1

89

52.9

136

0.027*

Table 16A

Introduction of complementary foods for IYC 6 – 23 months, by study group % of children who consumed the following food groups yesterday

Control

% Intervention

% Total

% Chi-square

p value n 322 552 874 aa Cereals 83.5 87.5 86.0 0.103 bb Potato, cassava, quequisque, malanga

12.4 17.8 15.8 0.037*

cc Ayote, platano maduro, Carrots, pipian

16.5 17.8 17.3 0.625

dd Beans, lentils 71.4 76.6 74.7 0.088 ee Green leaves 1.2 0.7 0.9 0.684ª ff Mango, papaya, bananos

10.6 17.6 15.0 0.005*

gg Other fruit of vegetable

39.4 38.0 38.6 0.682

hh Chicken liver, organ meat

1.2 1.1 1.1 1.000ª

ii Meats 14.9 16.7 16.0 0.494 jj Fish, sea or river food 0.6 0.7 0.7 1.000ª kk Eggs 27.3 30.4 29.3 0.330 ll Cheese, curd, milk products

50.0 48.9 49.3 0.757

mm Oil, lard, butter, fats 37.9 48.9 44.9 0.002* nn Chocolates, sweets, cakes, sugary foods

9.3 19.0 15.4 0.000*

Infant formula 0.3 0.4 0.3 1.000ª Food fortified with iron 23.3 23.2 23.2 0.972 Given a feeding bottle (0 - 23 months, n = 1152)

31.2 33.8 32.8 0.357

ª = with Yates correction

Table 17A Aggregated 7 food groups for child dietary diversity indicator

Food groups for dietary diversity Survey food groups.

From question 17

7 food group Assignation

label grains, roots and tubers aa, bb 4 legumes and nuts dd 5 dairy products ll, d, e 3 flesh foods (meat, fish, poultry and offal hh, ii, jj 1 egg kk 2 vitamin-A rich fruits and vegetables cc, ee, ff 6 other fruits and vegetables gg 7

Table 18A

Minimum dietary diversity by age and study groups for breastfed and non breastfed children

Breastfed and non breastfed children

Control % n

Intervention % n

Total % n

Chi-square p value

Proportion of children 6 – 23 months who received foods from 4 or more food groups n

46.6

322

51.6

552

49.8

874

0.150

Table 19A Minimum dietary diversity by age and study groups for breastfed children

Breastfed children

Control % n

Intervention % n

Total % n

Chi-square p value

Proportion of breastfed children 6 – 23 months who received foods from 4 or more food groups n

45.8

271

48.1

428

47.2

699

0.540


38.4

125

37.7

204

38.0

329

0.905

Proportion of breastfed children 12– 17 months who received foods from 4 or more food groups n

40.0

90

56.0

150

50.0

240

0.016*


71.4

56

60.8

74

65.4

130

0.208

Table 20A Minimum dietary diversity by age and study groups for non breastfed children

Non breastfed children

Control % n

Intervention % n

Total % n

Chi-square

p value Proportion of non breastfed children 6 – 23 months who received foods from 4 or more food groups n

51.0

51

63.7

124

60.0

175

0.118

Proportion of non breastfed children 6 – 11 months who received foods from 4 or more food groups n (insufficient sample)

40.0 5

70.0

30

65.7

35

0.424ª

Proportion of non breastfed children 12 – 17 months who received foods from 4 or more food groups n

45.0

20

62.1

29

55.1

49

0.238

Proportion of non breastfed children 18 – 23 months who received foods from 4 or more food groups n

57.7

26

61.5

65

60.4

91

0.735


Table 21A Proportion of children 6 – 23 months with minimum meal frequency by age and

study groups for breastfed and non breastfed children Control

% n

Intervention % n

Total % n

Chi-square p value

Proportion of breastfed and non breastfed children 6 – 23 months who received solid, semi-solid and soft foods (plus 2 or more milk feeds for non breastfed children) the minimum number of times or more n

70.8

322

72.5

552

71.9

874

0.599


study groups for breastfed children Control

% n

Intervention % n

Total % n

Chi-square p value

Proportion of breastfed children 6 – 23 months who received solid, semi-solid and soft foods or milk feeds the minimum number of times or more n

68.3

271

69.2

428

68.8

699

0.804


69.6

125

64.2

204

66.3

329

0.316


65.6

90

72.0

150

69.6

240

0.293


69.6

56

77.0

74

73.8

130

0.343


study groups for non-breastfed children Control

% n

Intervention % n

Total % n

Chi-square p value

Proportion of non breastfed children 6 – 23 months who received the minimum number of times or more n

84.3

51

83.9

124

84.0

175

0.942

Proportion of non breastfed children 6 – 11 months who received solid, semi-solid and soft foods the minimum number of times or more n

80.0 5

83.3

30

82.9

35

1.000ª


95.0

20

89.7

29

91.8

49

0.888ª


76.9

26

81.5

65

80.2

91

0.618


Table 24A Proportion of children 6 – 23 months with minimum acceptable diet by age and study

groups for breastfed and non breastfed children Control

%

Intervention %

Total %

Chi-square p value

Proportion of children 6 – 23 months (breastfed and non breastfed) with minimum acceptable diet

32.9

36.1

34.9

0.349


groups for breastfed children Control

%

Intervention %

Total %

Chi-square p value

Proportion of breastfed children 6 – 23 months with minimum acceptable diet

36.2 39.3 38.1 0.412


31.2 29.9

30.4

0.804


31.1 47.3 41.3 0.013*


55.4 48.6 51.5 0.449


groups for non breastfed children Non breastfed children (Indicator not comparable with WHO indicator)

Control%

Intervention %

Total %

Chi-square p value

Proportion of non breastfed children 6 – 23 months with minimum acceptable diet

15.7 25.0 22.3 0.179


0 30.0 25.7 0.385ª


15.7 37.9 28.6 0.081

Proportion of non breastfed children 18– 23 months with minimum acceptable diet

19.2 16.9 17.5 1.000ª


Table 27A Proportion of children 6 – 23 months who consumed iron-rich or iron fortified foods,

by age and study groups Control

% n

Intervention % n

Total % n

Chi-square p value

Proportion of children 6 – 23 months who received an iron-rich food or fortified food for IYC, or fortified in the home. n

34.5

322

35.9

552

35.4

874

0.677


29.2

130

34.2

234

32.4

364

0.333


36.4

110

36.3

179

36.3

289

0.993


40.2

82

38.1

139

38.9

221

0.755

Table 28A Proportion of children 6 – 23 months who consumed a) meats or b) fortified foods

by age and study groups

Control % n

Intervention% n

Total % n

Chi-square p value

a) Meat:

Proportion of children 6 – 23 months who received meat

16.5

322

18.3

552

17.6

874

0.492


12.3

130

20.5

234

17.6

364

0.049*


13.6

110

19.6

179

17.3

289

0.197


26.8

82

12.9

139

18.1

221

0.010*

b) Fortified foods:

Proportion of children 6 – 23 months who received fortified food

23.6

322

23.2

522

23.3

874

0.889


23.1

130

19.2

234

20.6

364

0.385


28.2

110

22.9

179

24.9

289

0.314


18.3

82

30.2

139

25.8

221

0.050*

Documents

30.4.10 Analysis of Baseline Survey for: CARE CENTROAMERICA, … · 2011. 1. 14. · 30.4.10 Analysis of Baseline Survey for: CARE CENTROAMERICA, NICARAGUA. PROYECTO VENTANA DE OPORTUNIDAD