| Summary: | Research report submitted in partial fulfillment of the requirements for the degree of Master of Science in Medicine field: child health- neurodevelopment in the Faculty of heath Sciences University of the Witwatersrand
2017 === Introduction: The WHO (World Health Organization) (2008) stated that infant and young child feeding practices directly affect the nutritional status of children of two years of age and under. Two fundamental stages in child development are the prenatal period and the first two years after birth - the so called “first 1000 days of life”. During that stage of development, rapid growth will occur; however any nutritional deprivation experienced may cause perpetual damage to the child for the rest of the child’s life. Growth is used globally as an indicator of a child’s wellness and is associated with their survival rate. Placing focus on and improving infant and young child feeding practices in this age group of children, is vital to promote growth, health and development (WHO, 2008). Wasting exists in South Africa at a low prevalence and stunting persists and is at a prevalence of 26% in children under 3 years of age (Shisana et al., 2013). Breastfeeding practices in South Africa are also known not to be at an optimal level. Though there is a large amount of literature on infant feeding practices in the context of the PTMCT (Prevention of Mother-To-Child Transmission), there are only a few publications that have described the association between infant feeding practices and growth during infancy. Furthermore the lack of historical information on infant feeding practices hinder the possibility to assess how infant feeding practices and its relation to infant growth, have changed since the Integrated Nutrition Program that was put in to place in 1995.
Aim: This study aims to determine the association between infant feeding practices and growth at 1 and 2 years of age in the Birth to Twenty Cohort in 1990-1992.
Method: The study is a secondary analysis study using data from the prospective Birth to Twenty cohort study which included 3273 children. The exposure variables in this study were infant feeding practices at 1 and 2 years (infants ever breastfed, duration of breastfeeding and age at introduction of solid and semi solid foods). The exposure variables were growth at 1 and 2 years (HAZ (Height-for-Age Z–score), WHZ (Weight-for-Height Z-score), stunting and wasting). Covariates associated with child growth were included in the analysis: household socio economic status, household water access, household density, maternal education, child health and disease status, ethnicity, parity, birth weight and gestational age. Multilinear regressions were used to assess whether the association between infant feeding practices and growth remains after adjusting for the covariates.
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Results: The primary Birth to Twenty study had more than 35% loss to follow up at 18 years. Participants included in the statistical sample were compared to participants excluded from the analytical sample according to their demographic data and birth characteristics. The two samples differed in their ethnic composition (p<0.001), their quality of access to water facilities (p<0.01, level of maternal education (p<0.00) and gestational age (p<0.03). In this study, 97.3% of infants were ever breastfed, the mean duration of breastfeeding was 11.6 months and the mean age at introduction of solid and semi-solid foods was 3.6 months. The prevalence of stunting at 1 and 2 years was 8.4 % and 20.5% respectively. The prevalence of wasting at 1 and 2 years was 2.2% and 4.8% respectively. A month’s increase in duration of breastfeeding was associated with a decrease in HAZ by 0.01 and 0.02 z-score at one and two years respectively. A month’s increase in the duration of breastfeeding was associated with an increase in stunting. No statistically significant associations were seen between the other infant feeding variables and growth indices (ever breastfed, WHZ, and wasting).
Conclusion: A negative association was observed between duration of breastfeeding and HAZ at one and two years. This study contributes to other studies that noted this association without accounting for the quality of complementary feeds given during the duration of breastfeeding. This information provides a baseline form of evidence and information against which current infant feeding practices and growth can be compared to. === MT 2018
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