Skip to main content
Top
Published in: Maternal and Child Health Journal 10/2016

01-10-2016

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

Authors: Khem Pokhrel, Keiko Nanishi, Krishna C. Poudel, Kalpana Gaulee Pokhrel, Kalpana Tiwari, Masamine Jimba

Published in: Maternal and Child Health Journal | Issue 10/2016

Login to get access

Abstract

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.
Literature
1.
go back to reference United Nations Children’s Fund. (1998). The state of world’s children. New York, USA. United Nations Children’s Fund. (1998). The state of world’s children. New York, USA.
2.
go back to reference World Health Organization. (2010). Fact sheet: Infant and young child feeding. Geneva. Accessed on December 13, 2012. World Health Organization. (2010). Fact sheet: Infant and young child feeding. Geneva. Accessed on December 13, 2012.
3.
go back to reference United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF, World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012). United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF, World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).
4.
go back to reference Bryce, J., Boschi-Pinto, C., Shibuya, K., Black, R. E., & Group WCHER. (2005). WHO estimates of the causes of death in children. Lancet, 365(9465), 1147–1152.CrossRefPubMed Bryce, J., Boschi-Pinto, C., Shibuya, K., Black, R. E., & Group WCHER. (2005). WHO estimates of the causes of death in children. Lancet, 365(9465), 1147–1152.CrossRefPubMed
5.
go back to reference World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva. World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva.
6.
go back to reference World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva. World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva.
7.
go back to reference Ruel, M. T., & Menon, P. (2002). Discussion Paper Briefs. Creating a child feeding index using the demographic and health surveys: An example from Latin America. Washington, DC: International Food Policy Research Institute. Ruel, M. T., & Menon, P. (2002). Discussion Paper Briefs. Creating a child feeding index using the demographic and health surveys: An example from Latin America. Washington, DC: International Food Policy Research Institute.
8.
go back to reference Arimond, M., & Ruel, M. T. (2002). Progress in developing an infant and child feeding index: An example using the Ethiopia demographic and health survey 2000. Washington, DC: International Food Policy Research Institute. Arimond, M., & Ruel, M. T. (2002). Progress in developing an infant and child feeding index: An example using the Ethiopia demographic and health survey 2000. Washington, DC: International Food Policy Research Institute.
9.
go back to reference Ruel, M. T., & Menon, P. (2002). Child feeding practices are associated with child nutritional status in Latin America: Innovative uses of the demographic and health surveys. Journal of Nutrition, 132(6), 1180–1187.PubMed Ruel, M. T., & Menon, P. (2002). Child feeding practices are associated with child nutritional status in Latin America: Innovative uses of the demographic and health surveys. Journal of Nutrition, 132(6), 1180–1187.PubMed
10.
go back to reference Sawadogo, P. S., Martin-Prével, Y., Savy, M., Kameli, Y., Traissac, P., Traoré, A. S., & Delpeuch, F. (2006). An infant and child feeding index is associated with the nutritional status of 6- to 23-month-old children in rural Burkina Faso. Journal of Nutrition, 136(3), 656–663.PubMed Sawadogo, P. S., Martin-Prével, Y., Savy, M., Kameli, Y., Traissac, P., Traoré, A. S., & Delpeuch, F. (2006). An infant and child feeding index is associated with the nutritional status of 6- to 23-month-old children in rural Burkina Faso. Journal of Nutrition, 136(3), 656–663.PubMed
11.
go back to reference Ministry of Health and Population, Nepal. (2011). Nepal Demographic and Health Survey: New Era, ICF International Calverton, Maryland. Kathmandu. Ministry of Health and Population, Nepal. (2011). Nepal Demographic and Health Survey: New Era, ICF International Calverton, Maryland. Kathmandu.
12.
go back to reference Ministry of health and population, Nepal. (2004). Nepal nutrition policy and strategy. Kathmandu. Ministry of health and population, Nepal. (2004). Nepal nutrition policy and strategy. Kathmandu.
13.
go back to reference Ministry of Health and Population. (2006). Nepal safe Motherhood policy. Kathmandu: Department of Health Services. Ministry of Health and Population. (2006). Nepal safe Motherhood policy. Kathmandu: Department of Health Services.
14.
go back to reference Ministry of Health and Population Nepal. (2011). Annual report 2010/11. Kathmandu: Department of Health Service. Ministry of Health and Population Nepal. (2011). Annual report 2010/11. Kathmandu: Department of Health Service.
15.
go back to reference Pandey, S., Tiwari, K., Senarath, U., Agho, K. E., Dibley, M. J., & Network, S. A. I. F. R. (2010). Determinants of infant and young child feeding practices in Nepal: Secondary data analysis of Demographic and Health Survey 2006. Food and Nutrition Bulletin, 31(2), 334–351.CrossRefPubMed Pandey, S., Tiwari, K., Senarath, U., Agho, K. E., Dibley, M. J., & Network, S. A. I. F. R. (2010). Determinants of infant and young child feeding practices in Nepal: Secondary data analysis of Demographic and Health Survey 2006. Food and Nutrition Bulletin, 31(2), 334–351.CrossRefPubMed
16.
go back to reference Khanal, V., Sauer, K., & Zhao, Y. (2013). Determinants of complementary feeding practices among Nepalese children aged 6-23 months: Findings from Demographic and Health Survey 2011. BMC Pediatrics, 13(131), 1471–2431. Khanal, V., Sauer, K., & Zhao, Y. (2013). Determinants of complementary feeding practices among Nepalese children aged 6-23 months: Findings from Demographic and Health Survey 2011. BMC Pediatrics, 13(131), 1471–2431.
17.
go back to reference Agho, K. E., Dibley, M. J., Odiase, J. I., & Ogbonmwan, S. M. (2011). Determinants of exclusive breastfeeding in Nigeria. BMC Pregnancy Child Birth, 11(2), 1471–2393. Agho, K. E., Dibley, M. J., Odiase, J. I., & Ogbonmwan, S. M. (2011). Determinants of exclusive breastfeeding in Nigeria. BMC Pregnancy Child Birth, 11(2), 1471–2393.
18.
go back to reference Patel, A., Badhoniya, N., Khadse, S., Senarath, U., Agho, K. E., Dibley, M. J., & Netwoork, S. A. I. F. R. (2010). Infant and young child feeding indicators and determinants of poor feeding practices in India: Secondary data analysis of National Family Health Survey 2005-06. Food and Nutrition Bulletin, 31(2), 314–333.CrossRefPubMed Patel, A., Badhoniya, N., Khadse, S., Senarath, U., Agho, K. E., Dibley, M. J., & Netwoork, S. A. I. F. R. (2010). Infant and young child feeding indicators and determinants of poor feeding practices in India: Secondary data analysis of National Family Health Survey 2005-06. Food and Nutrition Bulletin, 31(2), 314–333.CrossRefPubMed
19.
go back to reference District Development Committee. (2011). District profile of Makawanpur, Nepal. Makawanpur district, Hetauda. District Development Committee. (2011). District profile of Makawanpur, Nepal. Makawanpur district, Hetauda.
20.
go back to reference Department of Health Services, Ministry of Health and Population. (2010). Health management information system, caste coding system. Kathmandu. Department of Health Services, Ministry of Health and Population. (2010). Health management information system, caste coding system. Kathmandu.
21.
go back to reference District Health Office. (2011). District Health Report of Makawanpur District of Nepal. Makawanpur. District Health Office. (2011). District Health Report of Makawanpur District of Nepal. Makawanpur.
22.
go back to reference Bennett, S., Woods, T., Liyanage, W. M., & Smith, D. L. (1991). A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat, 44(1), 98–106. Bennett, S., Woods, T., Liyanage, W. M., & Smith, D. L. (1991). A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat, 44(1), 98–106.
23.
go back to reference Roche, A. F., & Davila, G. H. (1974). Differences between recumbent length and stature within individuals. Growth, 38(3), 313–320.PubMed Roche, A. F., & Davila, G. H. (1974). Differences between recumbent length and stature within individuals. Growth, 38(3), 313–320.PubMed
24.
go back to reference Van den Broeck, J., Willie, D., & Younger, N. (2009). The World Health Organization child growth standards: Expected implications for clinical and epidemiological research. European Journal of Pediatrics, 168(2), 247–251.CrossRefPubMed Van den Broeck, J., Willie, D., & Younger, N. (2009). The World Health Organization child growth standards: Expected implications for clinical and epidemiological research. European Journal of Pediatrics, 168(2), 247–251.CrossRefPubMed
25.
go back to reference Howe, L. D., Galobardes, B., Matijasevich, A., Gordon, D., Johnston, D., Onwujekwe, O., … Hargreaves, J. R. (2012). Measuring socio-economic position for epidemiological studies in low- and middle-income countries: A methods of measurement in epidemiology paper. International Journal of Epidemiology, 41(3), 871–886.CrossRefPubMedPubMedCentral Howe, L. D., Galobardes, B., Matijasevich, A., Gordon, D., Johnston, D., Onwujekwe, O., … Hargreaves, J. R. (2012). Measuring socio-economic position for epidemiological studies in low- and middle-income countries: A methods of measurement in epidemiology paper. International Journal of Epidemiology, 41(3), 871–886.CrossRefPubMedPubMedCentral
26.
go back to reference Howe, L. D., Hargreaves, J. R., & Huttly, S. R. (2008). Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerging Themes in Epidemiology, 5(3), 1742–7622. Howe, L. D., Hargreaves, J. R., & Huttly, S. R. (2008). Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerging Themes in Epidemiology, 5(3), 1742–7622.
27.
go back to reference Ergo, A., Gwatkin, D. R., & Shekar, M. (2009). What difference do the new WHO child growth standards make for the prevalence and socioeconomic distribution of undernutrition? Food and Nutrition Bulletin, 30(1), 3–15.CrossRefPubMed Ergo, A., Gwatkin, D. R., & Shekar, M. (2009). What difference do the new WHO child growth standards make for the prevalence and socioeconomic distribution of undernutrition? Food and Nutrition Bulletin, 30(1), 3–15.CrossRefPubMed
28.
go back to reference Vyas, S., & Kumaranayake, L. (2006). Constructing socio-economic status indices: How to use principal components analysis. Health Policy Plan, 21(6), 459–468.CrossRefPubMed Vyas, S., & Kumaranayake, L. (2006). Constructing socio-economic status indices: How to use principal components analysis. Health Policy Plan, 21(6), 459–468.CrossRefPubMed
29.
go back to reference Blumberg, S. J., Bialostosky, K., Hamilton, W. L., & Briefel, R. R. (1999). The effectiveness of a short form of the Household Food Security Scale. American Journal of Public Health, 89(8), 1231–1234.CrossRefPubMedPubMedCentral Blumberg, S. J., Bialostosky, K., Hamilton, W. L., & Briefel, R. R. (1999). The effectiveness of a short form of the Household Food Security Scale. American Journal of Public Health, 89(8), 1231–1234.CrossRefPubMedPubMedCentral
30.
go back to reference Gulliford, M. C., Mahabir, D., & Rocke, B. (2004). Reliability and validity of a short form household food security scale in a Caribbean community. BMC Public Health, 16, 4–22. Gulliford, M. C., Mahabir, D., & Rocke, B. (2004). Reliability and validity of a short form household food security scale in a Caribbean community. BMC Public Health, 16, 4–22.
31.
go back to reference Melgar-Quinonez, H. R., Zubieta, A. C., McNelly, B., Nteziyaremye, A., Gerardo, M. F., & Dunford, C. (2006). Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines. Journal of Nutrition, 136(5), 1431S–1437S.PubMed Melgar-Quinonez, H. R., Zubieta, A. C., McNelly, B., Nteziyaremye, A., Gerardo, M. F., & Dunford, C. (2006). Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines. Journal of Nutrition, 136(5), 1431S–1437S.PubMed
32.
go back to reference Zhang, J., Shi, L., Chen, D. F., Wang, J., & Wang, Y. (2013). Effectiveness of an educational intervention to improve child feeding practices and growth in rural China: Updated results at 18 months of age. Maternal and Child Nutrition, 9(1), 118–129.CrossRefPubMed Zhang, J., Shi, L., Chen, D. F., Wang, J., & Wang, Y. (2013). Effectiveness of an educational intervention to improve child feeding practices and growth in rural China: Updated results at 18 months of age. Maternal and Child Nutrition, 9(1), 118–129.CrossRefPubMed
33.
go back to reference Penny, M. E., Creed-Kanashiro, H. M., Robert, R. C., Narro, M. R., Caulfield, L. E., & Black, R. E. (2005). Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: A cluster-randomized controlled trial. Lancet, 365(9474), 1863–1872.CrossRefPubMed Penny, M. E., Creed-Kanashiro, H. M., Robert, R. C., Narro, M. R., Caulfield, L. E., & Black, R. E. (2005). Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: A cluster-randomized controlled trial. Lancet, 365(9474), 1863–1872.CrossRefPubMed
34.
go back to reference Saha, K. K., Frongillo, E. A., Alam, D. S., Arifeen, S. E., Persson, L. A., & Rasmussen, K. M. (2008). Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh. American Journal of Clinical Nutrition, 87(6), 1852–1859.PubMedPubMedCentral Saha, K. K., Frongillo, E. A., Alam, D. S., Arifeen, S. E., Persson, L. A., & Rasmussen, K. M. (2008). Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh. American Journal of Clinical Nutrition, 87(6), 1852–1859.PubMedPubMedCentral
35.
go back to reference Roy, S. K., Fuchs, G. J., Mahmud, Z., Ara, G., Islam, S., Shafique, S., … Chakraborty, B. (2005). Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately malnourished children in Bangladesh. Journal of Health Population and Nutrition, 23(4), 320–330. Roy, S. K., Fuchs, G. J., Mahmud, Z., Ara, G., Islam, S., Shafique, S., … Chakraborty, B. (2005). Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately malnourished children in Bangladesh. Journal of Health Population and Nutrition, 23(4), 320–330.
36.
go back to reference Dewey, K. G., Cohen, R. J., Brown, K. H., & Rivera, L. L. (1999). Age of introduction of complementary foods and growth of term, low-birth-weight, and breast-fed infants: A randomized intervention study in Honduras. American Journal of Clinical Nutrition, 69(4), 679–686.PubMed Dewey, K. G., Cohen, R. J., Brown, K. H., & Rivera, L. L. (1999). Age of introduction of complementary foods and growth of term, low-birth-weight, and breast-fed infants: A randomized intervention study in Honduras. American Journal of Clinical Nutrition, 69(4), 679–686.PubMed
37.
go back to reference Arimond, M., & Ruel, M. T. (2004). Dietary diversity is associated with child nutritional status: Evidence from 11 demographic and health surveys. Journal of Nutrition, 134(10), 2579–2585.PubMed Arimond, M., & Ruel, M. T. (2004). Dietary diversity is associated with child nutritional status: Evidence from 11 demographic and health surveys. Journal of Nutrition, 134(10), 2579–2585.PubMed
38.
go back to reference Zhang, J., Shi, L., Wang, J., & Wang, Y. (2009). An infant and child feeding index is associated with child nutritional status in rural China. Early Human Development, 85(4), 247–252.CrossRefPubMed Zhang, J., Shi, L., Wang, J., & Wang, Y. (2009). An infant and child feeding index is associated with child nutritional status in rural China. Early Human Development, 85(4), 247–252.CrossRefPubMed
39.
go back to reference Caulfield, L., Richard, S., Rivera, J., Musgrove, P., & Black, R. (2006). Stunting, wasting, and micronutrient deficiency disorders. Disease control priorities in developing countries. Washington, DC: The World Bank. Caulfield, L., Richard, S., Rivera, J., Musgrove, P., & Black, R. (2006). Stunting, wasting, and micronutrient deficiency disorders. Disease control priorities in developing countries. Washington, DC: The World Bank.
40.
go back to reference Knops, N. B., Sneeuw, K. C., Brand, R., Hille, E. T., den Ouden, A. L., Wit, J. M., et al. (2005). Catch-up growth up to ten years of age in children born very preterm or with very low birth weight. BMC Pediatrics, 5(26), 1471–2431. Knops, N. B., Sneeuw, K. C., Brand, R., Hille, E. T., den Ouden, A. L., Wit, J. M., et al. (2005). Catch-up growth up to ten years of age in children born very preterm or with very low birth weight. BMC Pediatrics, 5(26), 1471–2431.
41.
go back to reference Stoelhorst, G. M., Rijken, M., Martens, S. E., van Zwieten, P. H., Feenstra, J., Zwinderman, A. H., et al. (2003). Developmental outcome at 18 and 24 months of age in very preterm children: A cohort study from 1996 to 1997. Early Human Development, 72(2), 83–95.CrossRefPubMed Stoelhorst, G. M., Rijken, M., Martens, S. E., van Zwieten, P. H., Feenstra, J., Zwinderman, A. H., et al. (2003). Developmental outcome at 18 and 24 months of age in very preterm children: A cohort study from 1996 to 1997. Early Human Development, 72(2), 83–95.CrossRefPubMed
Metadata
Title
Undernutrition Among Infants and Children in Nepal: Maternal Health Services and Their Roles to Prevent it
Authors
Khem Pokhrel
Keiko Nanishi
Krishna C. Poudel
Kalpana Gaulee Pokhrel
Kalpana Tiwari
Masamine Jimba
Publication date
01-10-2016
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 10/2016
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-016-2023-z

Other articles of this Issue 10/2016

Maternal and Child Health Journal 10/2016 Go to the issue