Household food security is associated with early childhood language development: results from a longitudinal study in rural Bangladesh

Background Although household food security (HHFS) has been linked to academic performance in school children, its association with early childhood development has received less attention, particularly in low‐income countries. We investigated the association of HHFS with subsequent language development of children at 18 months of age in rural Bangladesh. Methods We followed 1439 infants born in 2002–2003 to the mothers in Maternal and Infant Nutrition Intervention in Matlab study, a large intervention trial conducted in rural Bangladesh. A HHFS scale was created from data collected from mothers during pregnancy. At 18 months, children's language (expression and comprehension) development was assessed using a Bengali adaptation of MacArthur's Communicative Development Inventory which was based on mothers' report of their children's ability to comprehend and express words in different categories. General linear regression models were used to examine the association between HHFS and language development at 18 months of age adjusting for potential confounders. Results Household food security was associated with language comprehension (B = 0.19, 95% CI = 0.09, 0.30, P < 0.001) and expression (B = 1.01, 95% CI = 1.00, 1.02, P < 0.01) at 18 months of age. Mean language comprehension and expression at 18 months of the children in higher quartiles of HHFS were higher (P < 0.05) than those of the children in lower quartiles. Conclusions Household food security is positively associated with subsequent language development of rural Bangladeshi children. Early language development has been reported to predict later child development. Therefore, strategies to ensure HHFS status in Bangladesh and similar settings should be considered for optimum child development.     

Evaluation of the impact of weaning food messages on infant feeding practices and child growth in rural Bangladesh.

In rural Bangladesh, a community-based weaning intervention used volunteers to teach complementary feeding to families of 62 breast-fed infants aged 6-12 mo. Over 5 mo, treatment children gained on average 0.46 SD (approximately 460 g) more in weight-for-age (WAZ) than the 55 control subjects, and were approximately 0.5 kg heavier at the final measure. The differences were statistically significant (P < 0.001). The percent median weight-for-age (WAPM) of treatment children held steady at 76% of the National Center for Health Statistics' reference, whereas the WAPM of control subjects dropped from 78% to 72%. The increase in percentage points of severe malnutrition (below -3 WAZ) was only 5% in the treatment group compared with 26% in the control subjects. Treatment children consumed a significantly greater percent of their energy and protein requirements from complementary foods than did control subjects. The affordable complementary foods consisted mainly of cereal porridge with oil and brown sugar. These findings suggest that educational interventions teaching families to feed hygienic, simple, cheap, energy-enriched complementary foods to breast-fed infants after 5-6 mo can improve child growth, even under impoverished conditions.     

Maternal feeding practices associated with food neophobia

The current study examined the associations between children's and mother's food neophobia and parental feeding practices. Eighty-five mothers of 3- to 12-year old children (M=5.7years; 52% girls) completed a questionnaire online about food neophobia and feeding practices. Mothers with children high in food neophobia used more restriction for health and less monitoring. Mothers with food neophobic children and mothers who were themselves food neophobic also reported that they do not make healthy foods readily available for their children. Mothers high in food neophobia also used more restriction for weight. This study is a starting point for understanding the link between neophobia and feeding practices, but future longitudinal work is needed in order to determine direction of effects. However, interventions could be created to help parents understand the importance of feeding practices for promoting children's food acceptance.     

Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh

BACKGROUND: The World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. OBJECTIVE: We evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. DESIGN: The prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. RESULTS: Mean (+/-SD) birth weight was 2697 +/- 401 g; 30% weighed < 2500 g. Mean body weight at 12 and 24 mo was 7.9 +/- 1.1 kg and 9.7 +/- 1.3 kg, respectively. More appropriate IFPs were associated (P < 0.001) with greater gain in weight and length during infancy. Prior IFPs were also positively associated (P < 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P < 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. CONCLUSIONS: Our results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries.     

Factors associated with infant feeding practices after hospital discharge

OBJECTIVE: To assess factors associated with infant feeding practices on the first day at home after hospital discharge. METHODS: A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. RESULTS: Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. CONCLUSIONS: On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.     

Household food insufficiency is associated with poorer health

The purposes of this study were to estimate the prevalence of household food insufficiency in Canada, to identify sociodemographic characteristics of households most likely to report food insufficiency and to examine the relationship between food insufficiency and physical, mental and social health. These objectives were achieved through an analysis of data from the 1996/1997 National Population Health Survey. An estimated 4% of Canadians, 1.1 million people, were found to be living in food-insufficient households. Single-parent families, households reporting their major source of income as welfare, unemployment insurance or workers' compensation, those who did not own their own homes and households in Western Canada were more likely to report food insufficiency. The likelihood of reporting food insufficiency increased dramatically as income adequacy deteriorated. Individuals from food-insufficient households had significantly higher odds of reporting poor/fair health, of having poor functional health, restricted activity and multiple chronic conditions, of suffering from major depression and distress, and of having poor social support. Individuals in food-insufficient households were also more likely to report heart disease, diabetes, high blood pressure and food allergies. Men in food-insufficient households were less likely to be overweight; after adjusting for potentially confounding variables, no other associations were found between food insufficiency and body mass index. These findings suggest that food insufficiency is one dimension of a more pervasive vulnerability to a range of physical, mental and social health problems among households struggling with economic constraints.     

A summary index of infant and child feeding practices is associated with child growth in urban Shanghai

ABSTRACT: BACKGROUND: Recently, an infant and child feeding index (ICFI) constructed on brief recalls of breastfeeding, feeding frequency and food diversification was assumed to provide long-term prediction about child feeding practices. The aim of this study was to investigate the association between the cross-sectional ICFI (CS-ICFI) or longitudinal ICFI (L-ICFI) and child anthropometric indices in downtown Shanghai, China. METHODS: The prospective cohort study included 180 infants aged 5-7 mo with their main caregivers who were visited 3 times every 6 months over 12 months. A CS-ICFI was constructed for each visit by using data on feeding practices based on 24-h and 7-d recalls. An L-ICFI was constructed with use of the 3 CS-ICFIs. The associations between ICFI and length-for-age z score (LAZ), weight-for-age z score (WAZ), and weight-for-length z score (WLZ) were examined. The stability of the CS-ICFI was assessed by using repeatability coefficient (RC). RESULTS: The L-ICFI was positively associated with LAZ and WAZ at Visit 3 (beta=0.151, P=0.040 and beta=0.173, P=0.024, respectively). Moreover, the CS-ICFI at Visit 1 was positively associated with LAZ, WAZ and WLZ (beta=0.160, P=0.029; beta=0.191, P=0.009; beta=0.176, P=0.020) at Visit 3, and the CS-ICFI at Visit 3 was also positively associated with LAZ (beta=0.176, P=0.016). Stability of the CS-ICFI was shown by the value of 0.14 (95% CI: 0.07, 0.31) of the RC, which differed significantly from 0 (P<0.05). CONCLUSIONS: The ICFI constructed on brief recalls based on cross-sectional studies can be used to evaluate the effects of child feeding practice on child growth.     

Household food insecurity is associated with adult health status

The prevalence of household food security, which reflects adequacy and stability of the food supply, has been measured periodically in the United States and occasionally in high-risk groups or specific regions. Despite a plausible biological mechanism to suggest negative health outcomes of food insecurity, this relation has not been adequately evaluated. This study was conducted in the Lower Mississippi Delta region to examine the association between household food insecurity and self-reported health status in adults. A two-stage stratified cluster sample representative of the population in 36 counties in the Delta region of Arkansas, Louisiana, and Mississippi was selected using list-assisted random digit dialing telephone methodology. After households were selected and screened, a randomly selected adult was interviewed within each sampled household. Data were collected to measure food security status and self-reported mental, physical, and general health status, using the U.S. Food Security Survey Module and the Short Form 12-item Health Survey (SF-12). Data were reported on a sample of 1488 households. Adults in food-insecure households were significantly more likely to rate their health as poor/fair and scored significantly lower on the physical and mental health scales of the SF-12. In regression models controlling for income, gender, and ethnicity, the interaction between food insecurity status and race was a significant predictor of fair/poor health and lower scores on physical and mental health. Household food insecurity is associated with poorer self-reported health status of adults in this rural, high-risk sample in the Lower Mississippi Delta.     

Responsive complementary feeding in rural Bangladesh

It is now widely recognized that malnutrition can partly be attributed to caregiver-child interaction during feeding episodes. Current conceptual frameworks emphasize the importance of responsiveness (including active and social behaviour), psychomotor abilities of the child to self-feed, and a non-distracting feeding environment. The present observational study had three main objectives: (1) to define operationally key terms such as responsive and active feeding and observe their frequency in a rural Bangladesh sample; (2) to examine whether self-feeding, responsive and active behaviours of the mother and child varied with child's age and amounts eaten; and (3) to determine associations between mother and child behaviours. Fifty-four mother-child pairs were observed during one feeding episode and behaviours were coded for 5 categories, namely self-feeding, responsive, active, social and distracting behaviours. Children were between 8 and 24 months of age. Results indicated that the five behaviours could be observed and reliably coded. Two-thirds of mothers had an active feeding style but only a third were responsive; the two styles did not overlap. With older children, mothers encouraged more eating and more self-feeding, but children did not feed themselves more; instead older children were more negatively responsive (refusing offered food). Positively responsive mothers tended to have active children who explicitly signaled their desire for food or water, and who ate more mouthfuls of food. Positively active mothers adopted different strategies to encourage eating, such as verbally directing the child to eat, focusing, and temporarily diverting. These mothers tended to have children who were negatively responsive and refused food. Children accepted on average 5.31 mouthfuls of food and rejected 2.13. Mothers who used intrusively active strategies (e.g. force feeding) tended to have children who were both positively and negatively responsive, thus partially reinforcing her forceful behaviour. Thus, the responsive feeding framework, once operationalized, has the potential to identify specific behaviours that support or impede mother-child interaction during complementary feeding.     

Education and infant survival in rural Bangladesh

This paper explores the mechanism through which socioeconomic status affects infant deaths. The data used here come from a prospective study in rural Bangladesh. Both neonatal deaths and postneonatal deaths were found to be higher in number among those whose mothers have no schooling. Again, education of the mother has been found to be related to gestational month at termination and this gestational month at termination (which is the maturity of the newborn) determines the neonatal death. The other factors affecting infant mortality were the height of the mother and the weight of the infant. The taller the mother, the fewer the neonatal and post-natal deaths. The weight of the infant has a direct relationship to its survival during infancy.     

Individual weight change is associated with household food security status

This study examined the relation between household food security status and current measured weight and change in self-reported weight over 12 mo using data from the 1999-2000 and 2001-2002 National Health and Nutrition Examination Surveys. Current measured BMI categories were as follows: underweight (<18.5 kg/m(2)), overweight (> or =25 kg/m(2)), and obese (> or =30 kg/m(2)). Change in self-reported weight used 2 cut-off points, i.e., a gain/loss of at least 2.27 kg (5 lb) and at least 4.54 kg (10 lb). Household food security categories were as follows: fully secure, marginally secure, insecure without hunger, and insecure with hunger. Multivariate analyses were adjusted for race/ethnicity, household income, education level, and current health status. Compared with women in households that were fully food secure, women in households that were marginally food secure [odds ratio (OR) 1.58] and food insecure without hunger (OR 1.76) were significantly more likely to be obese. Compared with women in households that were fully food secure, those in households that were marginally food secure were significantly more likely to gain at least 4.54 kg (OR 1.68). Compared with men in households that were fully food secure, men in households that were marginally food secure were more likely to be obese and to gain at least 4.54 kg, but these effects were smaller in magnitude than those for women and insignificant in some specifications. This study corroborates previous cross-sectional associations between intermediate levels of food insecurity and obesity for women, and it finds an association between intermediate levels of food insecurity and 12-mo weight gain for women.     

Safe-delivery practices in rural Bangladesh and its associated factors: evidence from Bangladesh demographic and health survey-2004

OBJECTIVES: This study examined the safe-delivery practices and its associated factors among rural Bangladeshi women. DESIGN: Cross-sectional survey data from Bangladesh Demographic and Health Survey (BDHS) 2004 were used. SETTING: Rural Bangladesh. PARTICIPANTS: A total of 3874 ever-married rural women age 10-49 years. Measurements: Age, education, working, religion, clinic visit, association with media, place and types of attendants at delivery. RESULTS: About 94% deliveries took place at homes and 67% were assisted by the untrained traditional birth attendants called Dai. The qualified doctors and nurses (professionals) assisted only 9% of the deliveries while about 13% are by the trained traditional birth attendants. Age group has a significant effect on safe-delivery practices. Education of the respondents as well as their partner's has direct effect on delivery practices. The uneducated women were less likely to have their delivery assisted by the medically trained persons (MTPs) while women with 10 or more years of schooling had 29 times higher probability than the uneducated women. Currently working and religion had also statistically significant. Mass media influences directly delivery practices in rural areas. The women who listen to radio and watch television had more than 2 times higher probability of having delivery assisted by MTPs than that of non-user counterparts. There is more than 4 times higher chance of delivery assisted by the MTPs than that of women with no reading of news papers or magazines. CONCLUSIONS: Delivery practices in rural Bangladesh are unsafe, took place at homes, conducted by untrained traditional birth attendants and associated positively with demographic, socio-economic, cultural and programmatic factors.     

Household food insecurity with hunger is associated with women's food intakes, health and household circumstances

This study investigated food intake patterns and contextual factors related to household food insecurity with hunger among a sample of 153 women in families seeking charitable food assistance in Toronto. Women in households characterized by food insecurity with severe or moderate hunger over the past 30 d (as assessed by the Food Security Module) reported lower intakes of vegetables and fruit, and meat and alternatives than those in households with no hunger evident. Women were more likely to report household food insecurity with hunger over the past 12 mo and 30 d if they also reported longstanding health problems or activity limitations, or if they were socially isolated. The circumstances that women identified as precipitating acute food shortages in their households included chronically inadequate incomes; the need to meet additional, unusual expenditures; and the need to pay for other services or accumulated debts. Women who reported delaying payments of bills, giving up services, selling or pawning possessions, or sending children elsewhere for a meal when threatened with acute food shortages were more likely to report household food insecurity with hunger. These findings suggest that expenditures on other goods and services were sometimes foregone to free up money for food, but the reverse was also true. Household food insecurity appears inextricably linked to financial insecurity.     

Factors associated with oral contraceptive discontinuation in rural Bangladesh

Oral contraceptives (OCs) account for half of all modern contraceptive methods used in Bangladesh, however, discontinuation remains fairly high in OC use. This paper identifies factors associated with discontinuation of OC use, where discontinuation refers to cessation of OC use in the 6 months prior to the survey. The data for this study were drawn from a survey on OC compliance in rural Bangladesh. A total of 1600 OC users, current or past, aged 15 to 49 years were interviewed; of these, 36% discontinued OC use. Of the women who discontinued, 47% reported the experience of side-effects as the main reason for OC discontinuation. Multivariate analysis identified lack of fieldworker's visit as the strongest predictor of OC discontinuation; women who were not visited by fieldworkers had a four-fold risk of discontinuing OC use. Discontinuation of OC use decreased with increased duration of use and number of living children. OC discontinuation was associated with side-effect experiences, lack of husband's support in OC use and failure to purchase OCs. Of great concern is that about 70% of the women who were at risk of unintended pregnancy were not using any method of contraception following OC discontinuation. Husband's education was positively associated with the substitution of OCs with another contraceptive method. Effective OC use should be advocated through adequate counselling about how to take it correctly, the possibility of side-effects and their proper management and, more importantly, the possible alternative contraceptive method should OCs prove unsatisfactory or unsuitable. Better provider-client interactions along with improved access to the newly established community clinics could be instrumental in the continued and effective use of OCs.     

Association of infant feeding practices in the general population with infant growth and stool characteristics

This was a prospective cohort study of 976 infants from birth to 12 months of age. Infants were fed breast milk, goat infant formula, cow infant formula, or a combination of formula and breast milk during the first 4 months of age. Data on type of milk feeding and infant growth (weight and height) were collected at birth and at 4, 8, and 12 months during routine clinical assessment. The number and consistency of bowel motions per day were recorded based on observational data supplied by the mothers. Infants fed breast milk or goat or cow infant formula during the first 4 months displayed similar growth outcomes. More of the infants fed cow infant formula had fewer and more well-formed bowel motions compared with breast-fed infants. The stool characteristics of infants fed goat formula resembled those of infants fed breast milk.     

Iron status of women is associated with the iron concentration of potable groundwater in rural Bangladesh

Women of reproductive age are at a high risk of iron deficiency, often as a result of diets low in bioavailable iron. In some settings, the iron content of domestic groundwater sources is high, yet its contribution to iron intake and status has not been examined. In a rural Bangladeshi population of women deficient in dietary iron, we evaluated the association between groundwater iron intake and iron status. In 2008, participants (n = 209 with complete data) were visited to collect data on 7-d food frequency, 7-d morbidity history, 24-h drinking water intake, and rice preparation, and to measure the groundwater iron concentration. Blood was collected to assess iron and infection status. Plasma ferritin (μg/L) and body iron (mg/kg) concentrations were [median (IQR)] 67 (46, 99) and 10.4 ± 2.6, respectively, and the prevalence of iron deficiency (ferritin < 12 μg/L) was 0%. Daily iron intake from water [42 mg (18, 71)] was positively correlated with plasma ferritin (r = 0.36) and total body iron (r = 0.35) (P < 0.001 for both). In adjusted linear regression analyses, plasma ferritin increased by 6.1% (95% CI: 3.8, 8.4%) and body iron by 0.3 mg/kg (0.2, 0.4) for every 10-mg increase in iron intake from water (P < 0.001). In this rural area of northern Bangladesh, women of reproductive age had no iron deficiency likely attributable to iron consumed from drinking groundwater, which contributed substantially to dietary intake. These findings suggest that iron intake from water should be included in dietary assessments in such settings.