Nutritional counseling improves dietary diversity and feeding habits of Zambian malnourished children admitted in Rainbow nutritional programs
Journal Title: Biomedicine & Prevention - Year 2017, Vol 2017, Issue 1
Abstract
Background. Adequate nutrition is essential for child growth, health and development. In sub-Saharan African countries children’s feeding habits are often inappropriate, with monotonous diet, insufficient in food quality and frequency. Poor feeding practices are influenced by many factors, such as low maternal education and food insecurity, and are directly correlated with children’s dietary diversity, nutritional status and health. Objective. To assess feeding practices and dietary consumption of Zambian malnourished children admitted in Rainbow Supplementary Feeding Programs (SPFs) in Ndola area; to evaluate the impact of nutritional counseling on feeding habits; to investigate the association between dietary diversity and response to nutritional rehabilitation. Material and Methods. Mothers/guardians of under-five malnourished children admitted in Rainbow SFPs within 2015 and 2016 were interviewed on children’s feeding practices. A sample data of 37 children (mean age in months was 23.2 ±8.6 SD; 62.2% of the children were males) was eligible for the analysis. Children’s nutritional status was evaluated according to WHO/UNICEF methodology. Dietary assessment (24-hours food recall) was collected at two times: admission (baseline: T1) and discharge (follow up: T2). Dietary diversity was defined based on 12 food groups, and dietary adequacy was given to a goal of 7 scoring points. Children’s dietary intakes were compared with age- and gen-der-specific recommendations for energy and protein (WHO/FAO/ONU). Data was analyzed using Statistical Package for Social Science (SPSS) version 21.0. Non-parametric tests were used to examine the differences in feeding habits and dietary characteristics between T1 and T2. The association between dietary diversity scores (DDS) and response in nutritional rehabilitation was also investigated. Results. At baseline children’s dietary characteristics were very poor: mean DDS_T1 was 5 ±1 SD, mean meal frequency was 3 ±0.8 SD, with more than 78% of the sample having ≤ 3 meals/day. At T1 the 73% of the sample was not boiling water before drinking it. When dietary intakes were compared with recommended WHO/FAO/ONU guidelines, our analysis showed nearly 65% of children consuming < 75% of required daily amount of energy, and almost 20% of children consuming <75% of required daily amount of protein. After nutritional counseling significant improvements were observed in general children’s feeding habits (DDS_T2: 7 ±1 SD; meal frequency: 5 ±0.6 SD with only one child still having ≤ 3 meals/day). Energy and macronutrients intakes significantly rose (p<0.001), with only 12% of children still consuming < 75% of required daily amount of energy, but all reaching that target for protein. Consistent changes in food groups intake were noted, especially when considering fruit and vegetables (p<0.001), and animal-source food (p=0.031). At T2 more than half of the sample have started to treat drinking-water (p<0.001). Higher dietary diversity at follow up was positively associated with nutritional response: DDS_T2 >7 was significantly correlated with greater gain in MUAC-for-age Z-scores (p=0.046). Conclusion. Zambian children’s diet is often monotonous and inadequate, with inappropriate feeding practices exposing vulnerable children to malnutrition. Nutritional counselling within SFPs is effective in the education of mothers/guardians, driving changes in children’s feeding practices such as dietary diversity, meal quality and frequency. Nutritional counseling is therefore an essential activity to be routinely integrated into SFPs. Enhancing dietary counseling with targeted messages on a culturally appropriate balanced diet and acquired counseling skills of community volunteers, could even strengthen the effectiveness of community-based program treating malnutrition.
Authors and Affiliations
Stefania Moramarco, Giulia Amerio, Lweendo Chafula Muyaba, Daniele Bonvecchio, Emiliano Abramo, Leonardo Palombi, Ersilia Buonomo
Keywords
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- EP ID EP334974
- DOI 10.19252/00000005D
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