Determinants of Infant and Young Child Feeding Practices of Children With Severe Acute Malnutrition in Agrarian and Pastoralist Settings of Ethiopia.

Abstract

Previous research has established determinants of young child feeding (IYCF) practices in the general child population, but determinants of these practices in children with severe acute malnutrition (SAM) are unknown. This study assessed the determinants of IYCF practices among children aged 6-23 months with SAM and under SAM treatment in a pastoralist and a predominantly agrarian setting in Ethiopia. As part of the baseline survey for the R-SWITCH cluster randomized control trial, we screened ~28,000 under-fives and included 486 children aged 6-23 months with SAM and under SAM treatment. Multivariable regression analysis was used to identify determinants on household, caregiver and child levels. Minimum meal frequency (MMF) was similar between children from the agrarian (53.9%) and pastoralist (51.9%) setting. The prevalence of children with minimum dietary diversity (MDD) was low overall but higher among pastoralist children (31.5%) than children from the agrarian setting (19.0%; p = 0.012). The consumption of egg/flesh foods was lower among pastoralist children (5.6%) than agrarian children (16.9%, p = 0.085). Caregiver literacy was positively associated with a higher likelihood of MMF (IRR = 1.21; 95% CI:1.02-1.43; p = 0.030), while caregiver depression was associated with a lower likelihood of MMF (RR = 0.97; 95% CI:0.95-0.99; p = 0.003). Improved water source (RR = 1.59; 95% CI:1.06-2.38; p = 0.037), caregiver literacy (RR = 2.04; 95% CI:1.25-3.34; p = 0.002), caregiver MDD (RR = 2.21; 95% CI:1.60-3.05; p ≤ 0.001), older children(RR = 1.05; 95% CI: 1.02-1.08;p ≤ 0.001), and pastoralist setting (RR = 1.62; 95% CI:1.07-2.44; p = 0.014) were associated with a significantly higher likelihood of meeting MDD. Conversely, caregiver depression (RR = 0.94; 95% CI:0.90-0.97; p < 0.001), caregiver mobility restriction (IRR = 0.94; 95% CI:0.89-1.00; p = 0.025), and food insecurity (RR = 0.64; 95% CI:0.41-1.01; p = 0.05) were associated with reduced MDD likelihood. Caregiver community involvement (IRR = 1.12; 95% CI:1.00-1.26; p = 0.038), caregiver MDD (RR = 1.67; 95% CI:1.10-2.53; p = 0.043), and older children (RR = 1.08; 95% CI:1.05-1.12; p < 0.001) were associated with increased egg/flesh-food consumption among children, while living in a pastoralist setting was associated with reduced it (RR = 0.36; 95% CI:0.13-0.97; p = 0.038). Integrated and Targeted interventions recommended: caregiver literacy/depression support to improve IYCF; livelihood-specific foods (eggs/flesh, fruits/vegetables); WaSH enhancements; community engagement; and IYCF counseling within CMAM programs.