Abstract
The Demographic and Health Survey (DHS) data provide a strong base for evaluating guidelines for child feeding across multiple countries. Based on DHS data, breastfeeding was widely practiced and a high percentage of mothers continued to breastfeed through the first year of life in 20 countries that were identified by the World Bank as among the poorest economically. However, many mothers in these 20 countries began feeding sweetened liquids and solid food to their babies earlier than recommended by the World Health Organization (WHO). In one of these countries – Cambodia – we compared DHS infant feeding data collected in 2000 to date from 2005 and assessed the WHO core feeding indicators recommended for healthy growth. In Cambodia, fewer children exhibited underweight in most age categories in 2005 than in 2000; however, the prevalence of stunting among 18- to 23-month-old children was not less in 2005 and remained above 50%. In this Cambodian study, prevalence of compliance with all age-based breastfeeding and complementary feeding WHO indicators increased significantly between surveys in 2000 and 2005, except percent of mothers currently breastfeeding at 12–15 months which remained relatively constant (2000: 87.1%; 2005: 89.6%). In particular, among Cambodian 0- to 5-month-old infants, prevalence of exclusive breastfeeding increased fivefold and prevalence of early breastfeeding initiation increased threefold between 2000 and 2005. While prevalence of meeting the WHO complementary feeding indicator for feeding diversity increased between 2000 and 2005, the prevalence remained very low for the WHO indicators of feeding diversity and minimal acceptable diet among various age groups. However, multivariate regression models demonstrated no overall general association of the WHO feeding indicators with undernutrition measures of underweight and stunting. There were some age-specific associations: 0- to 5-month-old infants, whose mothers were in compliance with both exclusive breastfeeding and breastfeeding initiation guidance and were at significantly lower risk of underweight; and 6- to 11-month-old infants, whose mothers were in compliance with the overall solid food guidance and were at significantly reduced risk of stunting but not underweight. Our primary finding from models of the WHO feeding indicators in Cambodia was a consistent positive association of reduction in risk of stunting and underweight with increases in relative wealth. In conclusion, many mothers in developing countries continue to breastfeed their babies through the first 12 months as recommended by the WHO. Among the WHO feeding indicators, focus on complementary feeding, particularly increased diversity of foods among children over 6 months of age, is indicated as a potential approach to reduce the high prevalence of stunting among children over 18 months of age in poor countries.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- DHS:
-
Demographic and Health Surveys
- NCHS:
-
National Center for Health Statistics, USA
- PAHO:
-
Pan American Health Organization
- Under-5children:
-
Children under the age of 5 years
- WHO:
-
World Health Organization
- Xmochild:
-
x-month-old child
References
Adams JW, Porter I, Gill IS, Nisha Agrawal N, Goh C, Conway T. Sharing growth: equity and development in Cambodia: Equity Report 2007 World Bank; 2007.
Arimond M, Ruel MT. Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr 2004:134(10):2579–85.
Bahl R, Frost C, Kirkwood BR, Edmond K, Martines J, Bhandari N, Arthur P. Bull World Health Organ. 2005;83:418–26.
Bhandari N, Bahl, Mazumdar S, Martines J, Black RE, Bhan MK, Infant Feeding Study Group. Lancet. 2003;361:1418–23.
Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HPS, Shekar M for the Maternal and Child Undernutrition Study Group. Lancet. 2008;371:41–64.
Black RE, Morris SS, Bryce J. Lancet. 2003;361:2226–34.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, Deonis M, Ezzati M, Mathers C, Rivera J. Lancet. 2008;371:243–60.
Blakely T, Hales S, Kieft C, Wilson N, Woodward A. Bull World Health Organ. 2005;83:118–26.
Bryce J, Coitinho D, Damton-Hill I, Pelletier D, Pinstrup-Andersen P for the Maternal and Child Undernutriton Study Group. Lancet. 2008;371:65–81.
Butte NF, Wong WW, Hopkinson JM, Heinz CJ, Mehta NR, Smith EOB. Energy requirements derived from total energy expenditure and energy deposition during the first two years of life. Am J Clin Nutr. 2000;72:1558–69.
Cambodian Ministry of Health. Kingdom of Cambodia National Poverty Reduction Strategy: 2003–2005 [Online]. 2002. http://poverty2.forumone.com/files/cambodia_PRSP2.pdf. Accessed May 2008.
Carmichael R. Cambodia struggles to save mothers, even as it succeeds in reducing child deaths [Online]. VOANews. 2009. http://www.voanews.com/english/2009-11-10-voa60.cfm?renderforprint=1. Accessed 11 Nov 2009.
Collins D, Lewis E, Steinberg K. Scaling up child survival interventions in Cambodia: the cost of national programme resource needs. Final report. Geneva: USAID, BASICS, WHO; 2007.
Croft T. DHS Data Editing and Imputation [Online]. 2005. http://www.measuredhs.com/accesssurveys/DHS_Data_Editing_TCroft.pdf. Accessed 7 July 2005.
Dara T. Cambodia: nutrition overview [Online]. 2003. http://www.wpro.who.int/NR/rdonlyres/B612EEDE-D156-4B69-8346-44729EF1511F/0/cam.pdf. Accessed 14 May 2008.
Dewey KG. Guiding principles for feeding non-breastfed children 6–24 months of age. Geneva, Switzerland: World Health Organization; 2005.
Dewey KG. Guiding principles for complementary feeding of the breastfed child. Pan American Health Organization, WHO; 2004.
Dewey KG, Cohen RJ, Rollins NC, Informal Working Group on Feeding of Nonbreastfed Child. Food Nutr Bull. 2004;25:377–402.
Di Renzo G, Rosati A, Sarti R, Cruciani L, Cutuli A. Does fetal sex affect pregnancy outcome? Gender Med. 2007;4:19–30.
Espo M, Kumala T, Maleta K, Cullinan T, Salin M, Ashorn P. Determinants of linear growth and predictors of severe stunting during infancy in rural Malawi. Acta Paediatr. 2002;91:1364–70.
Galler JR, Ramsey FC, Harrison RH, Brooks R, Weiskopf-Bock S. Infant feeding practices in Barbados predict later growth. J Nutr. 1998;128(8):1328–35.
Garza C, de Onis M. Food Nutr Bull. 2004;25:S5–14.
Gonzalez-Cossio T, Rivera-Dommarco J, Moreno-Macias H, Monterrubio EA, Sepulveda J. J Nutr. 2006;136:2928–33.
Hoddinott H, Maluccio JA, Behrman JR, Flores R, Martorell R. Lancet. 2008;371:411–6.
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. Lancet. 2003;362:65–71.
Lane C. Scaling up for better health in Cambodia [Online]. Geneva: WHO; 2007. http://www.hlfhealthmdgs.org/Documents/Scaling%20Up%20for%20Better_Health_Cambodia_mq2.pdf. Accessed 14 May 2008.
Lauer JA, Betran AP, Victoria CG, De Onis M, Barros AJ. BMC Med. 2004 [Online] http://www.biomedcentral.com/1741-7015/2/26.
Margai F. Geographic targeting of risk zones for childhood stunting and related health outcomes in Burkina Faso. World Health Popul. 2007;9:64–82.
Marriott BM, Campbell L, Hirsch E, Wilson D. Preliminary data from demographic and health surveys on infant feeding in 20 developing countries. J Nutr. 2007;137:518S–523S.
Marriott BP, White AJ, Hadden L, Davies JC, Wallingford JC. How well are infant and young child World Health Organization (WHO) feeding indicators associated with growth outcomes? An example from Cambodia. Matern Child Nutr. 2010;6(4):358–73.
Mendez MA, Adair LS. J Nutr. 1999;129:1555–62.
Merchant AT, Jones C, Kiure A, Kupka R, Fitzmaurice G, Herrera MG, Fawzi WW. Eur J Clin Nutr. 2003;57:1562–8.
Migeon BR. The role of X inactivation and cellular mosaicism in women’s health and sex-specific diseases. J Am Med Assoc. 2006;295:1428–33.
Nandy S, Irving M, Gordon D, Subramanian SV, Smith GD. Bull World Health Organ. 2005;83:210–6.
National Institute of Public Health and National Institute of Statistics (Cambodia) and ORC Macro. Cambodia Demographic and Health Survey 2005, Phnom Penh, Cambodia and Calverton, MD, USA; 2006.
National Institute of Statistics [Cambodia], Directorate General for Health[Cambodia], ORC Macro. Cambodia Demographic and Health Survey 2000, Phnom Penh, Cambodia and Calverton, MD, USA; 2002.
ORC Macro. Supervisor’s and editor’s manual for use with model “A” and “B” questionnaires MEASURE DHS+ Basic Documentation No. 5. Calverton, MD: ORC Macro; 2002.
ORC Macro. Description of the Demographic and Health Surveys Individual Recode Data File version 1.0 MEASURE DHS+. Calverton, MD: ORC Macro; 2007.
Pan American Health Organization (PAHO). Guiding principles for complementary feeding of the breastfed child. Pan American Health Organization, WHO; 2003.
Pavignani E. Health service delivery in post-conflict states. In: High level forum on the health millenium development goals (MDGs): selected papers, 2003–2005. Paris: World Bank & WHO; 2006. http://www.hlfhealthmdgs.org/Documents/WHOconferenceReportENG.pdf.
Peng YK, Hight-Laukaran V, Peterson AE, Perez-Escamilla R. J Nutr. 1998;128:1672–80.
Piwoz EG, Huffman SL, Quinn VJ. Promotion and advocacy for improved complementary feeding: can we apply the lessons learned from breastfeeding? [see comment][erratum appears in Food Nutr Bull. 2003 Jun;24(2):239]. Food Nutr Bull. 2003;24(1):29–44.
Ruel MT, Menon P. J Nutr. 2002;132:1180–7.
Rutstein S, Johnson K. The DHS Wealth Index DHS Comparative Reports No. 6. Calverton, MD: ORC Macro; 2004.
Rutstein S, Rojas G. Guide to DHS Statistics [Online]. ORC Macro; 2003. http://www.measuredhs.com/accesssurveys/Guide_DHS_Statistics.pdf. Accessed 7 July 2005.
Rutstein SO, Rojas G. Guide to DHS Statistics. Calverton, MD: ORC Macro; 2006.
SAS Institute Inc. SAS/STAT9.1 Users Guide. Cary, NC: SAS Institute Inc.; 2004.
Shah S, Selwyn B, Luby S, Merchant AT, Bano R. Prevalence and correlates of stunting among children in rural Pakistan. Pediatr. Int. 2003;45:49–53.
UNICEF. Mother support group network promotes exclusive breastfeeding in Cambodia [Online]. 2008. http://www.unicef.org/infobycountry/cambodia_43437.html. Accessed 14 May 2008.
UNICEF. The state of the world’s children: special edition: celebrating 20 years of the convention on the rights of the child. 2009. http://www.unicef.org/rightsite/sowc/pdfs/SOWC_Spec%20Ed_CRC_Main%20Report_EN_090409.pdf 92.
Van de Poel E, Hosseinpoor AR, Speybroeck N, Van Ourti T, Vega J. Bull World Health Organ. 2008;86:282–91.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS. Lancet. 2008;371:340–57.
Victora CG, Morris SS, Barros FC, Onis MD, Yip R. J Nutr. 1998;128:1134–8.
Ward M, Lee S, Lipper E. Failure-to-thrive is associated with disorganized intfant-mother attachment and unresolved maternal attachment. Infant Mental Health J. 2000;21:428–42.
WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age Methods and development. Geneva: World Health Organization; 2006.
World Bank. Cambodia data profile. World developers indicators database. Geneva: World bank; 2008a.
World Bank. Data and statistics: country classifications. Geneva: World bank; 2008b.
World Health Organization (WHO). Guiding principles for feeding non-breastfed children 6–24 months of age. Geneva: World Health Organization; 2005.
WHO. Child growth standards frequently asked questions [Online]. Geneva: WHO; 2008a. http://www.who.int/topics/nutrition_disorders/en/. Accessed May 2008.
World Health Organization (WHO). Indicators for assessing infant and young child feeding practices: conclusions of a consensus meeting held 6–8 November 2007 in Washington, DC, Part I: definitions. Geneva: WHO; 2008b.
World Health Organization (WHO). Monitoring achievement of the health-related Millennium Development Goals. Geneva: The Secretariat; 2008c.
Acknowledgments
The analyses represented in this chapter were completed while the first author was appointed as vice president, RTI International, RTP, NC and Principal Associate/Scientist, Abt Associates, Inc., Durham, NC, with support from Wyeth Nutrition. The Samueli Institute supported Bernadette Marriott in writing this chapter. The authors acknowledge the Journal of Nutrition and Maternal and Child Nutrition for granting permission to reprint tables and figures from previous publications of this work. Preliminary results included here for the 20-country study were presented at the conference “Advances in Meeting the Nutritional Needs of Infants Worldwide” held in San Francisco, CA, April 5, 2006.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Marriott, B.P., White, A., Hadden, L., Davies, J.C., Wallingford, J.C. (2012). Infant Feeding in 20 Developing Countries with Focus on Infant Undernutrition in Cambodia. In: Preedy, V. (eds) Handbook of Growth and Growth Monitoring in Health and Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1795-9_87
Download citation
DOI: https://doi.org/10.1007/978-1-4419-1795-9_87
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1794-2
Online ISBN: 978-1-4419-1795-9
eBook Packages: MedicineMedicine (R0)