Caregiver Feeding Behaviors and Their Relation to Growth and Dietary Diversity in Rural Bangladesh: An ancillary study of women and children participating in the JiVitA-4 complementary food supplementation trial
Chowdhury, Zaynah T.
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Background: Variations in child growth are explained by a myriad of factors including nutrition, hygiene and other environmental determinants. Feeding behaviors (responsive and non-responsive) are known to influence the development of eating behaviors and subsequent nutritional status. Limited knowledge exists about how responsive and non-responsive feeding behaviors in rural Bangladesh may influence child dietary intake and growth. Objective: This dissertation research aims to characterize young child feeding in rural northwestern Bangladesh, and assess the relationship between caregiver feeding behaviors and diet and growth at 24 months. Methods: In-depth interviews (n=30), focus group discussions (n=5) and in-home observations (n=10) were conducted to qualitatively assess caregiver feeding behaviors in Gaibandha, Bangladesh. Quantitative data were collected on 4846 mother-child dyads enrolled in a complementary food supplementation trial. Anthropometry (weight, length) and child diet (24-h recall) were collected. A context-specific 11-item feeding behaviors module was developed; factor analysis revealed 2 theoretically derived constructs of feeding: responsive (5 items) and forceful (6 items). Each was dichotomized to reflect low and high feeding behaviors, with approximately 2/3 of the sample reporting optimal feeding behaviors for both constructs (high responsive [70%], low forceful [66%]). Dietary diversity score (DDS; range 0-7) was derived using the diet recall data and was used to define minimum dietary diversity (MDD; score of 4 or more). Relations were examined using multivariate linear/logistic regression models, adjusting for confounders, intervention status, and study design. Results: In a setting with high undernutrition, caregivers fed their children in a way that they thought would increase intake. Two theoretically derived feeding constructs emerged in this population: responsive and forceful. Responsive feeding was positively associated with DDS (β: 0.11, 95% CI: 0.03, 0.19). No significant relations were seen with MDD or growth outcomes (p>0.05). Conversely, forceful feeding was negatively associated with WAZ (β: -0.16, 95% CI: -0.22, -0.11), WLZ (β: -0.20, 95% CI: -0.25, -0.14), and DDS (β: -0.13, 95% CI: -0.21, -0.05) and positively with underweight (OR: 1.38, 95% CI: 1.22, 1.56), wasting (OR: 1.55, 95% CI: 1.33), 1.81, and meeting MDD (OR: 0.78, 95% CI: 0.68, 0.88). No relationship was seen with LAZ or stunting (p>0.05). Conclusions: Caregivers in this setting fed in a way they thought would increase intake, fueled by the concern that their child is not eating enough. Findings suggest that even in the context of high undernutrition, non-responsive feeding behaviors (especially forceful) are associated with poor growth and dietary diversity among young children. Future longitudinal research is needed to better understand causality and test the efficacy of responsive feeding interventions on the promotion of child growth and diet.