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Infant and Young Child Feeding [message #1693] Fri, 28 March 2014 13:53 Go to previous message
lutterch@paho.org is currently offline  lutterch@paho.org
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Registered: March 2014
Location: Washington DC
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The Pan American Health Organization/World Health Organization (PAHO/WHO) and Helen Keller International (HKI) strongly support the current child food frequency question (Q558) in the questionnaire. The data generated from this question is widely used to calculate the WHO/UNICEF indicators for assessing infant and young child feeding practices, develop and strengthen policies and programs to support optimal feeding, monitor trends and evaluate the impact of policies and programs. In the face of new trends and developments in maternal and young child nutrition, we wish to propose the deletion of one question (Q446), one new question and a small modification to response options for Q558.

DELETIONS: We propose that Q446 ("In the first two months after delivery, did you receive a Vitamin A dose like (this/any of these)?" be deleted. The rationale is that WHO no longer recommends postpartum Vitamin A supplementation for women .

REVISIONS: We propose three new response options for Q558 ("Now I would like to ask you about liquids or foods that (NAME FROM 557) had yesterday during the day or night. I am interested in whether your child had the item I mention even it was combined with other foods.").

• Add back the option "Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or sweet biscuits?" (and adding the word "sweet" before biscuits). This option was included in the DHS 5 core questionnaire but not in the DHS 6 core questionnaire; however, many countries have continued to include it.

• Add two additional options: "Any soft drinks/soda/fizzy drinks/carbonated beverages?" and "Any savory snacks such as fried chips, crisps, or salted biscuits?"

Recent analyses of DHS datasets from 18 countries found significant consumption of sugary snack foods especially in Asia: 42%-75% among 18-23 month-olds. Having this option added back to the new DHS questionnaire will allow for monitoring trends in sugary food consumption. The reintroduction of the sugary foods option and two additional options are needed because there is clear evidence that diets high in sugar and salt are related to increasing rates of overweight among young children, long term impacts on chronic diseases and a high prevalence of dental caries. Such diets may also contribute to undernutrition by replacing breast-milk and more nutritious foods. A recent study by Helen Keller International (HKI) study showed that 45% and 43% of children 6-23 months of age in Cambodia consumed sugary and savory snacks in the previous 24 hours, respectively. In Nepal, these figures were 75% and 34%. Questions to assess the consumption of soft drinks have been used in large national surveys in Mexico and Brazil and by HKI in two countries so far. In Brazil in 2006, 12% of 2006 month old children consumed soft drinks. In the HKI study of capital cities of Cambodia, 19% of children 18-23 months of age consumed soft drinks and in Nepal, 2% did so

The data from the additional response options to Q558 will be used to develop new policies and programs to promote healthy child growth and prevent overweight and obesity, monitor trends in consumption of these foods and evaluate the impact of policies and programs to reduce their consumption. Preventing the increase in child obesity is also a global nutrition target endorsed by the World Health Organization (WHO) and so the information garnered from these additional options will contribute toward its achievement.

The proposed response options have been pretested and used in Cambodia, Nepal, Senegal and Tanzania and provide valid and reliable data. The response option on sugary foods was previously used extensively in previous versions of the DHS questionnaire. Tabulation of the date should be the same as is currently done for the other response options for Q558.

ADDITIONS:
1. A new question is needed because the International Code of Marketing of Breast-milk Substitutes (Code), adopted by nearly all DHS countries, prohibits the promotion of infant formula and other breast-milk substitutes. Such promotion is well documented to reduce breastfeeding. Nonetheless, data show that this provision of the Code is widely violated. A recent study conducted by HKI showed that 86% and 28% of women had read, heard or seen a commercial promotion in Cambodia and Nepal, respectively. A Save the Children study showed this figure to be 11% in Pakistan. This question will provide information relevant to increasing exclusive breastfeeding, one of the global nutrition targets endorsed by the World Health Assembly (WHA).

2. New Question: DURING YOUR PREGNANCY OR SINCE (NAME) WAS BORN/ HAVE YOU READ, HEARD OR SEEN A COMMERCIAL PROMOTION FOR INFANT FORMULA OR OTHER MILK TARGETED FOR BABIES?

This question could come after Q457 (what child was given to drink in first 3 days after delivery).

3. The data from the new question will be used to provide evidence for the need to strengthen countries' Code legislation and monitoring, and enforcement of their national laws that protect breastfeeding. It will also be used by programs to tailor breastfeeding messages to counteract inappropriate marketing of infant formula and other breast-milk substitutes. The proposed question has been extensively pretested and used most recently in Pakistan, Cambodia, China, Nepal, Senegal and Tanzania and provides valid and reliable data. Tabulation of the data should be in standard DHS format as a prevalence (those exposed to commercial promotion/those asked the question).

4. The new question is a priority for the reasons cited in #1 above. No question exists in the questionnaire on this important subject.

5. We are suggesting the deletion of one question, the addition of a one question and only small modifications to response options in another question. We consider all these changes important so that DHS maintains its status as the most comprehensive, up to date, and reliable source of information on infant and young child feeding and nutrition.

6. The proposed question and modifications to the options of an existing question are relevant for all DHS countries.
 
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