Association of feeding practices with growth in infants: a longitudinal observational study in a rural district of Pakistan.

Abstract

Background: Exclusive breastfeeding (EBF) is recommended for the first 6 months of an infant's life, but barriers to EBF persist due to sociocultural, economic and health-related factors in resource-poor settings. This study examines the association between feeding practices and malnutrition in a birth cohort from a rural district of Pakistan.

Methods: Data were collected from a cohort of n=2697 infants, up to 6 months of age, through routine household visits by community health workers. The study analysed demographic characteristics, feeding practices, anthropometric and health information of infants and their mothers.

Results: Breastfeeding practices varied, with EBF being more common in the first month, while predominant breastfeeding (breastmilk with non-milk liquids) was most prevalent from 1 to 6 months. Almost all (98.3%) infants had been breastfed at some point between birth and 6 months but <10% were being exclusively breastfed by 6 months of age, with a significant proportion already identified as wasting (14.7%), stunted (36.7%) and underweight (38.5%) at baseline (birth). Early initiation of complementary feeding or breastmilk alternatives before 4 months was significantly associated with increased odds of wasting by 6 months of age (adjusted OR (AOR)=4.14; 95% CI: 1.95 to 8.77; p<0.001). Infants not born in medical facilities had higher risks of wasting (AOR=2.43; 95% CI: 1.13 to 5.21) and underweight status (AOR=1.74; 95% CI: 1.13 to 2.71).

Conclusion: Our study indicates that infants were over four times more likely to be malnourished by 6 months if complementary feeding was initiated before 4 months of age. While causal relations/directionality cannot be established from these findings, we believe that parents may resort to suboptimal complementary feeding practices shortly after birth, due to perceived inadequate infant growth. A tailored approach addressing systemic barriers to optimal feeding practices is recommended for resource-constrained, nutrition-poor settings, such as rural Pakistan.