Association of infant and young child feeding practices with under-nutrition: evidence from the Nepal Demographic and Health Survey

Background: Childhood undernutrition remains a highly influential risk factor in terms of the global burden of disease. Increasing evidence links infant and young child feeding (IYCF) practices to undernutrition. However, the results are inconsistent, and more country-specific studies are needed.Objectives: To determine the associations between IYCF practices and nutritional outcomes among children aged 0-23 months using a nationally representative dataset.Methods: The study used data from the 2011 Nepal Demographic and Health Survey, and the data were analysed for children aged 0-23.9 months who had corresponding data for the outcome variables of interest (n=890). Multiple linear and logistic regressions were undertaken and adjusted for the complex design of the survey, controlling for child, maternal, household and community characteristics.Results: Of the 890 children included in the study, 83% received age-appropriate breastfeeding but only 48% were breastfed within 1 hour of birth. Exclusive breastfeeding under 6 months of age was associated with a higher weight-for-age Z-score (WAZ) and a lower probability of wasting, but the estimated effects were of borderline significance. A significant negative association was found between continued breastfeeding at 1 year and WAZ and weight-for-height Z-score (WHZ). Timely introduction of complementary feeding in children aged 6-8 months was associated with a higher WAZ [effect size (ES) 0.6, P<0.01] and higher WHZ (ES 0.6, P<0.05). Higher dietary diversity index (DDI) was associated with higher height-for-age Z-score (ES 0.1, P<0.05 for each DDI point). Children who achieved minimum meal frequency had a higher WAZ (ES 0.3, P<0.05).Conclusion: This is the first study to relate the wide ranges of IYCF indicators with child nutritional outcomes in Nepal, and it underscores the need to improve age-appropriate complementary feeding practices with a sustained focus on exclusive breastfeeding to reduce undernutrition in infants and young children.