中国部分地区婴幼儿喂养状况及国际比较研究

【目的】 了解我国研究地区婴幼儿喂养现状,比较该地区与全球发展中国家的婴幼儿喂养水平,探索我国婴幼儿喂养中存在的问题。 【方法】 采用横断面调查设计和多阶段分层随机抽样的方法,使用联合国儿童基金会(UNICEF)标准化问卷对我国中西部40个县3 708名2岁以下儿童看护人的喂养情况进行调查,分析世界卫生组织(WHO)2008年版《婴幼儿喂养评估指标》中的8个指标并与世界卫生组织 2010年公布的46个发展中国家的数据进行比较。 【结果】 调查地区早开奶率、6个月以下儿童纯母乳喂养率、1岁和2岁时持续母乳喂养率均低于发展中国家平均水平,在47个国家中分别位列第34、39、44和45名。辅食及时添加率、辅食添加种类合格率位列前20%,辅食添加普遍过早。 【结论】 调查地区婴幼儿喂养中主要存在开奶不及时、母乳喂养伴随喂水、过早添加辅食和母乳喂养持续时间短的问题。加强健康宣教,传播喂养知识,对婴幼儿喂养状况的改善具有积极作用。     

北京市高碑店地区9月龄婴儿喂养情况分析

目的 了解北京市朝阳区高碑店地区9月龄婴儿喂养现状,分析该地区婴儿喂养中存在的问题。方法 采用横断面调查,使用联合国儿童基金会标准化问卷,对北京市朝阳区高碑店地区529名9月龄婴儿的喂养情况进行调查,分析世界卫生组织(WHO)2008年版《婴幼儿喂养评估指标》中的8个指标。结果 调查地区早开奶率为64.9%,9个月时持续母乳喂养率为92.5%,适龄喂养率(即6个月以下进行纯母乳喂养,6~9月的婴儿在母乳喂养的同时添加辅食)为75.0%,辅食添加种类合格率为64.1%,但9月龄母乳喂养婴儿辅食添加频率合格率仅为17.6%,且辅食合理添加率仅为14.2%。结论 调查地区婴儿中母乳喂养情况较好,但存在适龄喂养率较低及辅食种类和辅食添加频率偏少的问题,应引起重视。     

贵州省贫困农村地区婴幼儿辅食喂养及体格发育调查

目的了解贵州省贫困农村地区6~23月龄婴幼儿辅食添加情况及对体格发育的影响,探讨改善婴幼儿辅食喂养的途径。方法采用分层多阶段整群随机抽样的方法,进行横断面调查,调查对象为贵州贫困农村地区6~23月龄婴幼儿及其看护人。通过膳食回顾法调查过去24小时婴幼儿食物摄入情况,分析辅食添加时间、辅食种类、喂养频率等。用年龄别身高Z值(HAZ)和年龄别体重Z值(WAZ)判断婴幼儿体格发育水平,分析辅食添加与生长迟缓、低体重的相关关系。结果辅食及时添加率为91.1%;首次添加辅食以谷类泥糊状食物为主,约占75%;摄入频率最高的是谷物、根茎、块茎类食物(94.1%),摄入频率最低的是其他蔬菜水果(30.5%),动物性食物(肉类)摄入率仅33.8%;母乳喂养婴幼儿频次合格率63.8%,种类合格率64.8%,频次和种类同时合格率(即辅食合格)仅43.5%,18~23月龄辅食合格率最高(56.7%);非母乳喂养婴幼儿频次合格率22.5%,种类合格率71.5%,频次和种类同时合格率(即辅食合格)仅16.7%,18~23月龄辅食合格率最高(20.2%)。母乳喂养婴幼儿,辅食不合格者生长迟缓率、低体重率高于辅食合格者,二者差异有统计学意义(P0.05);非母乳喂养婴幼儿,辅食不合格者生长迟缓率高于辅食合格者,二者差异有统计学意义(P0.05);辅食不合格者低体重率略高于辅食合格者,但二者差异无统计学意义。结论贵州省贫困农村地区婴幼儿辅食喂养存在问题,部分婴幼儿辅食添加时间不合理,辅食合格率较低。不合格辅食是导致生长迟缓和低体重的重要原因,应改善辅食营养状况。     

婴幼儿喂养方式与辅食添加现状调查

目的分析徐州市城区2岁以内婴幼儿喂养方式、断乳时间及辅食添加情况,为提高本地区儿童健康状况提供依据。方法随机抽取徐州市某社区医院535份2岁以下儿童健康检查记录表,统计其6个月内喂养方式、断乳时间及辅食添加情况。结果 6个月纯母乳喂养率为72.52%,混合喂养率为14.58%,人工喂养率为12.90%,平均断乳时间为14.66个月,91.96%的婴幼儿在4～6个月内添加辅食。结论徐州市城区婴幼儿母乳喂养率相对较低,母乳喂养的婴幼儿断乳较早,大多数家长能及时添加辅食。     

甘肃省贫困县6～23月龄婴幼儿喂养状况调查

目的了解甘肃省贫困县永靖县和榆中县6～23月龄婴幼儿喂养方式和辅食添加现状。方法采取整群抽样的方法,对6～23月龄的婴幼儿的主要喂养人进行问卷调查,调查婴幼儿的喂养方式以及辅食添加情况。结果共调查两县7个乡镇836名婴幼儿,其中18.2%的婴幼儿在出生1小时之内喂过母乳,母乳喂养率达到84.1%,12～15月龄持续母乳喂养率为29.6%,20～23月龄持续母乳喂养比例为8.7%,6个月内喂养方式:42.7%为基本纯母乳喂养,41.4%为混合喂养,15.9%为人工喂养。68.7%的婴幼儿辅食添加时间不当,其中分别有35.2%、33.5%的婴幼儿辅食开始添加时间过早或不及时,6～月龄婴幼儿辅食添加满足最少辅食添加品种的情况显著低于12～,18～23月龄组,且在6～月龄组中,母乳喂养的婴幼儿的辅食添加满足最低可接受膳食的情况显著低于非母乳喂养婴幼儿。结论甘肃省永靖和榆中两个贫困县6～23月龄婴幼儿的6个月内基本纯母乳喂养率较低,辅食添加时间、种类和次数不当是婴幼儿喂养的主要问题。     

四川省农村2岁以内婴幼儿喂养方式与辅食添加状况分析

[目的]了解四川省农村2岁以内婴幼儿喂养与辅食添加状况. [方法]利用2005年10月～2007年10月四川省农村学龄前儿童营养与健康状况相关危险因素调查,获取2岁以内共783名婴幼儿喂养方式与辅食添加状况调查资料,并进行描述性分析. [结果]婴幼儿开奶时间的中位数为5 h,其中出生后2 h内开奶的比例为37.3%;6月龄婴儿母乳喂养率、混合喂养率、人工喂养率分别为58.3%、36.7%和5.0%;婴儿平均断奶时间为7.6个月;27.2%的婴幼儿在出生后4月龄前已经添加辅食;6～8月龄的婴幼儿中还有12.6%尚未添加辅食;1岁时添加婴儿配方奶、普通奶、谷类、蔬果、蛋类、肉类、肝脏及血、豆类及其制品的比例分别为35.9%、65.5%、86.6%、69.8%、65.4%、69%、10.2%、25.9%. [结论]四川省农村婴幼儿母乳喂养率较低、辅食添加不合理,应普及母乳喂养观念,实时添加辅食,转变不良喂养行为.     

中国2岁以下婴幼儿喂养状况研究

目的分析中国2岁以内婴幼儿喂养状况及变化趋势。方法采用多阶段分层随机整群抽样的方法,在全国14个省、自治区、和直辖市的43个调查点中选取7204名2岁以下婴幼儿,利用婴幼儿家长调查问卷了解儿童喂养状况。结果2006年中国6个月内婴儿母乳喂养率为49.2%,城市为51.9%,农村为48.5%。6～24个月婴幼儿配方奶、普通奶类、谷类、畜肉类、水产品、蛋类、豆类及蔬菜水果的平均添加率分别为41.8%、47.6%、94.4%、78.0%、59.9%、87.4%、64.9%和90.2%。结论中国2岁以内婴幼儿喂养状况需要关注,纯母乳喂养率偏低,过早添加辅食与辅食添加不及时同时存在。尤其农村6个月内婴儿母乳喂养率呈下降趋势明显。     

永康市0~1岁婴幼儿辅食添加现状调查

目的调查永康市0~1岁婴幼儿辅食添加现状。方法采用分层随机抽样方法抽取2019年2月1日—2020年2月1日至永康市妇幼保健院儿保科体检的304例0~1岁婴幼儿为研究对象,采用问卷调查的方式收集婴幼儿辅食添加情况,分析其影响因素。结果304例婴幼儿中,食物添加率为96.38%(293/304),辅食添加种类中,谷类辅食添加最高为97.04%(295/304),其次为其他蔬菜水果57.89%(176/304),最低为肉类25.66%(78/304);6~8月龄组的婴幼儿中辅食添加种类合理率为60.38%(32/53),9~12月龄合理率为54.18%(136/251);6~8月龄母乳喂养婴幼儿辅食添加频率合理率为76.74%(33/43),未母乳喂养合理率为70.00%(7/10),9~12月龄母乳喂养婴幼儿辅食添加频率合理率为70.27%(104/148),未母乳喂养的为49.51%(51/103),最低可接受膳食率为38.82%(118/304)。多因素logistic回归分析显示,婴幼儿高月龄(OR=0.593)、家长专科及以上学历(OR=0.336)、在职人员(OR=0.254)、家长喂养知识评分高(OR=0.581)是0~1岁婴幼儿最低可接受膳食合格率的保护因素(P<0.05)。结论本地区0~1岁婴幼儿辅食添加合格率居高水平,辅食添加种类处于中低水平,母乳喂养的0~1岁婴幼儿辅食添加频率合理,但未母乳喂养的婴幼儿辅食添加频次不足。     

2002年北京市2岁以内婴幼儿营养与喂养状况调查

目的了解北京市2岁以内婴幼儿出生时营养、母乳喂养与辅食添加状况,为政府制定儿童营养政策提供依据。方法采取分层整群随机抽样方法,于2002年8至11月在北京市18个区县进行抽样调查。在取得知情同意的情况下,对422名2岁以内婴幼儿的家长进行面对面询问调查。结果北京市平均婴儿出生体重为3325g,低体重出生率和巨大儿出生率分别为2．8％和13．0％;4月龄内婴儿母乳喂养率、混合喂养率和人工喂养率分别为56．6％、33．9％和9．5％,城区混合喂养率明显高于郊区;婴幼儿平均断奶月龄为7．4个月;6月龄及以上婴幼儿的辅食添加率为99．4％,城区和郊区婴幼儿各类辅食的添加顺序一致,但郊区婴幼儿的辅食添加时间晚于城区,且蔬菜水果、水产品、食用油的添加频率低于城区。结论北京地区新生儿体格发育良好,应在社区加强婴幼儿喂养的健康教育,提高母乳喂养率,适当延长母乳喂养时间,并适时添加各类辅食。     

云南贫困农村地区0～6岁儿童营养不良影响因素分析

目的分析2006-2009年云南省贫困农村地区0～6岁儿童营养不良状况,探讨其影响因素。方法采用随机整群分层抽样的方法,抽取云南省4个贫困县农村地区4873名0～6岁儿童,通过询问调查、血红蛋白检测和膳食调查进行问卷调查,并测量身高、体重,采用Z评分法进行营养状况评价,计算营养不良率。采用非条件logistic回归多因素分析。结果 2006-2009年云南贫困农村地区6岁以下儿童低体重率为15.2%,生长迟缓率为11.5%,消瘦率为7.1%。排除了其他变量的影响后显示,儿童出生以后6个月喂养方式为母乳喂养的比混合喂养或人工喂养更不容易发生营养不良;儿童添加谷类、蛋类、水果、锌补充剂辅食不容易发生营养不良,儿童添加钙补充剂辅食容易发生营养不良。较早对2～5岁儿童添加动物肝脏、血辅食比较晚添加更不容易发生营养不良。结论儿童营养不良的影响因素主要有儿童出生后6个月内的喂养方式、2岁以下婴幼儿近一个月内辅食添加、2～5岁儿童辅食添加月龄、2～5岁儿童过去一年内食物添加及频率等。     

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.     

Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.     

Reduced Morbidity Motivated Adoption of Infant and Young Child Feeding Practices after Nutrition Education Intervention in Rural Malawi

This study assessed caregivers’ knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixed-methods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers’ reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child’s health benefits motivated mothers to adopt improved IYCF practices.     

基于8月龄婴儿的喂养行为评价方法与结果分析

目的 使用两种评价方法对调查地区户籍和流动8月龄婴儿的喂养行为进行分析,发现不合理喂养行为,为制定研究地区婴儿的喂养指导策略提供依据,同时对两种指标评价方法的优劣进行对比。方法 采用横断面研究,选取2014年在北京某社区接受常规儿童保健服务,排除早产、低出生体重、出生先天缺陷及心、肝、肾、血液系统疾病的所有8月龄婴儿为调查对象,并通过问卷收集婴儿喂养情况进行统计分析。结果 调查地区本市和流动8月龄婴儿在6月龄内辅食添加率分别为52.0%和65.1%(P<0.05)。8月龄婴儿喂养指数得分均值本市和流动分别为12.42±2.24和11.41±2.18(P<0.001)。喂养指数合格率本市大于流动(P=0.001)。喂养指数各分项中,过去24 h奶瓶喂养指数本市小于流动(P<0.001),过去1周食物添加频率中,奶类、鱼虾类、禽畜肉类、蔬菜水果类喂养指数本市大于流动(P<0.01)。婴儿早开奶率、最小膳食多样性、曾经母乳喂养率,本市均好于流动人口(P<0.05)。所有母乳喂养婴儿的最小合理膳食率均明显低于人工喂养婴儿(P<0.01)。结论 调查地区8月龄婴儿喂养情况本市好于流动,但整体状况不容乐观;两种评价方法各有千秋。     

Association between Mother’s Education and Infant and Young Child Feeding Practices in South Asia

The association between mother’s education and the World Health Organization’s (WHO’s) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother’s education and the WHO’s eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)—Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother’s education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.     

广东省母亲育儿营养知识态度调查分析

结果表明广东省４１４名０～１８个月婴幼儿的母亲育儿的营养知识缺乏，只有５１％的合格率，尤其是在普通营养知识和断奶过渡期喂养方面较薄弱。同时，母亲在育儿营养知识上存在不少误区，如认为４个月前的婴儿应添加辅食、肉汤比肉更有营养等。城郊和城镇的母亲育儿营养知识认知水平低于城市。在营养教育方案的设计上，应侧重于普通营养知识和婴儿断奶过渡期喂养知识的宣教，采取通俗易懂的教育方法，并加强城镇和农村的营养教育。     

Undernutrition Among Infants and Children in Nepal: Maternal Health Services and Their Roles to Prevent it

Objectives Appropriate infant and young child feeding (IYCF) for children aged 6–23 months includes adequate dietary diversity, appropriate meal frequency, and continued breastfeeding. Mothers receiving antenatal care (ANC) and postnatal care (PNC) may adopt better IYCF. This study examined the association of ANC or PNC attendance with IYCF and child nutrition status. Methods A cross-sectional study was performed on 400 mother–child pairs in rural Nepal. Mothers were interviewed about their history of ANC and PNC attendance and IYCF; the height and weight of their children were measured. IYCF was measured with infant and child feeding index (ICFI) aggregating scores of dietary diversity, meal frequency, continued breastfeeding, and dietary variety. Lower ICFI scores indicated poorer IYCF practices. Multiple regression and logistic regression examined the association of ANC and PNC attendance with ICFI scores and undernutrition, respectively. Results Absence of ANC (β = ?1.01, P = 0.011) and absence of PNC (β = ?1.01, P = 0.011) were negatively associated with ICFI scores. Additionally, absence of ANC was positively associated with underweight (AOR 3.37; 95 % CI 1.42–9.92 for children 6–11 months, AOR 3.43; 95 % CI 1.41–8.32 for children 12–23 months) and stunting (AOR 6.51; 95 % CI 2.11–20.10 for children 6–11 months, AOR 3.32; 95 % CI 1.50–7.31 for children 12–23 months). Similarly, children tended to be underweight and stunted if their mothers did not receive any PNC. Conclusion Absence of ANC and PNC were associated with poor IYCF, underweight, and stunting in children.     

Review of the Nutrition Situation in Jordan: Trends and Way Forward

Jordan is witnessing an escalating pace of nutrition transition, which may be associated with an increased burden of malnutrition and related non-communicable diseases. This review analyzes the nutrition situation in Jordan by exploring specific nutrition indicators, namely infant and young child feeding, low birthweight, micronutrient deficiencies, anthropometric indicators, and food consumption patterns. Results showed that although most children were ever breastfed and early initiation of breastfeeding had a two-fold increasing trend, rates of exclusive breastfeeding below 6 months of age and continued breastfeeding until two years of age were low. Complementary feeding indicators, particularly minimum diet diversity and minimum acceptable diet standards, were suboptimal. An overall low burden of stunting, wasting, and underweight among children under 5 years and remarkable progress in optimizing iodine status among school-aged children were reported. Conversely, the burden of low birthweight and overweight/obesity exacerbated, coexisting with anemia, vitamin A deficiency, and vitamin D deficiency. Overall, fruit and vegetable consumption were inadequate. The consumption of soft drinks and salt on the other hand was higher than recommended. This review acknowledges the double burden of malnutrition in Jordan and recommends the prioritization and evaluation of interventions towards improving the population’s nutritional status and achieving nutrition targets.