| Popis: |
Background: While nurturing care, including adequate nutrition and responsive caregiving and early learning, is critical to early childhood development, national surveys in Nepal highlight inequalities in feeding and parental caregiving practices. This study aimed to document and analyse infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under age five in Dhanusha district, Nepal. Methods: We used a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N=1360) when children were aged 0-12 months and a follow-up survey of the same mother-child dyads (N=1352) when children were 7-59 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices, respectively. We collected data on breastfeeding practices in a postpartum 6-week questionnaire and on complementary feeding and caregiving practices in the follow-up survey. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators. Results: The prevalence of feeding indicators varied. Ever breastfed (99%), exclusive breastfeeding in past 24-hours at 0-12 months (89%), and vegetable or fruit consumption (84%) were common, and minimum dietary diversity reached 63%. Problem areas were early initiation of breastfeeding (16%), feeding of colostrum (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), and animal-source food consumption (29%). Amongst caregiving indicators, access to books (7%), early stimulation and responsive caregiving (11%), and access to early childhood education (27%) were of particular concern, while 64% had access to toys and 71% received adequate care. Only 38% of children were developmentally on track. Younger children from poor households with young mothers who had not received antenatal visits and delivered at home were at risk of poor IYCF and caregiving practices. Conclusions: Poor IYCF and cognitive and socio-emotional caregiving practices are widely prevalent in lowland Nepal, which highlights the importance of improved integrated nutrition and caregiving interventions in resource-constrained settings. |
