CREATING A CHILD FEEDING INDEX USING THE DEMOGRAPHIC AND HEALTH SURVEYS: AN EXAMPLE FROM LATIN AMERICA
Creators: name: Ruel, Marie T.
name: Menon, Purnima
name: Ruel, Marie T.
name: Menon, Purnima
Publisher: name: Unknown
Year: 2002
Subjects: Food Security and Poverty

description: Data from the Demographic and Health Surveys (DHS) for five Latin American countries (seven data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for- age (HAZ). Urban/rural differences were also examined. The data sets used were Bolivia, 1994 and 1998; Colombia, 1995; Guatemala, 1995 and 1999; Nicaragua, 1998; and Peru, 1996. The variables used to create the index were: breastfeeding (whether the mother is currently breastfeeding the child); use of baby bottles in the previous 24 hours; dietary diversity (whether the child received selected food groups in the previous 24 hours); food group frequency (how many days the child received selected food groups in the past seven days); and meal (or feeding) frequency (how many times the child was offered solids or semisolid foods in the previous 24 hours (including meals and snacks). The index was made age-specific for 6–9-, 9–12-, and 12– 36-month age groups, and country- and age-specific feeding terciles were created. Bivariate analyses showed that feeding practices were strongly and statistically significantly associated with child HAZ in all seven data sets, especially after 12 months of age. Differences in HAZ between the lowest and highest feeding terciles remained significant for all countries except Bolivia, after controlling by multivariate analysis for potentially confounding influences. Multiple regression analyses also revealed that better feeding practices were more important for children from lower, compared to higher, socioeconomic status (Colombia 1995; Nicaragua 1998; Peru 1996); for children of ladino (Spanish speaking), compared to indigenous, origin (Guatemala 1995); for older (30–36 months), compared to younger, children (12–30 months); and for children of mothers with, compared to mothers without, primary schooling, or mothers with higher than secondary levels of education (Peru 1996). Urban mothers had consistently higher feeding practices scores than rural mothers, and their children had higher HAZ at all ages. Although breastfeeding rates and duration were lower in urban than in rural areas, as is typical of most countries in the developing world, children’s diets in urban areas of Latin America were consistently better than those of rural areas from the age of 6 months. Urban mothers were more likely than rural mothers to introduce complementary foods in a timely fashion, to use a greater variety of complementary foods (animal products in particular), and to offer their children complementary foods as frequently as recommended for their age. These findings provide strong empirical evidence of the higher quality of the diet of urban weaning-age children compared to their rural counterparts. Urban/rural differences in malnutrition prevalence paralleled the differences documented for child feeding practices—prevalence of stunting was systematically lower in urban than in rural areas, and countries with highest prevalence of stunting also had the lowest average child feeding index scores (Guatemala 1995, 1999; Peru 1996). This work shows that the data available in DHS data sets can be used for a variety of purposes, including to (1) describe and study the distribution of specific feeding practices by geographic area, or other characteristics of interest such as maternal schooling or household socioeconomic status; (2) create a child feeding index to quantify and illustrate associations between child feeding practices and child outcomes, thereby serving as an advocacy tool; and (3) identify practices and vulnerable groups that could be targeted by programs and policies to improve child feeding practices and overall child health and nutrition. In sum, greater use of the DHS data on child feeding practices should be promoted for research and analysis, as a source of guidance on program design and planning, and for advocacy.