Effects of Maternal Use of the Continuum of Care on Complementary Feeding Practices in Bangladesh: Cross-Sectional Study.

Background: The continuum of care (CoC) for maternal health, which includes ≥4 antenatal care (ANC) visits, delivery assisted by skilled birth attendants, and a postnatal care (PNC) visit within 48 hours of delivery, is a crucial health care package associated with survival and improved health outcomes for children and mothers. In addition, the CoC serves as a platform for delivering messages and counseling on child feeding practices. However, the effect of maternal use of the CoC on complementary feeding practices in Bangladesh remains unexamined.

Objective: This study aimed to estimate the effect of maternal use of CoC on complementary feeding practices among children aged 6 to 23 months in Bangladesh.

Methods: Data from 2 consecutive nationally representative surveys-the Bangladesh Demographic and Health Survey 2017-2018 and 2022-were analyzed. Observations corresponding to the CoC for maternal health and complementary feeding indicators, including (1) timely introduction of solid, semisolid, and soft food (ISSSF); (2) minimum meal frequency (MMF); (3) minimum dietary diversity (MDD); and (4) minimum acceptable diet (MAD), were merged to prepare the analyzed samples. The differences in complementary feeding practice indicators by maternal use of the CoC were observed using chi-square tests. Multivariable logistic regression models were used to observe the associations.

Results: The analysis included 887, 4967, 4967, and 4967 mother-child pairs for the timely ISSSF, MMF, MDD, and MAD indicators, respectively. The status of complementary feeding indicators was significantly different (P<.05) by maternal use of the full CoC, ≥4 ANC visits, status of receiving PNC within 48 hours of birth, maternal educational level, husband's educational level, maternal occupation, wealth index of families, maternal perceived problems with accessing health care, and division of residence. Mothers who received the full CoC were 29% and 32% more likely to meet the MDD (adjusted odds ratio [AOR] 1.29, 95% CI 1.10-1.51; P=.002) and MAD (AOR 1.32, 95% CI 1.13-1.55; P=.001) than those who did not receive the full CoC, respectively. Among the individual components of the CoC, mothers who received ≥4 ANC visits were 23%, 31%, and 34% more likely to meet the MMF (AOR 1.23, 95% CI 1.05-1.45; P=.01), MDD (AOR 1.31, 95% CI 1.13-1.51; P<.001), and MAD (AOR 1.34, 95% CI 1.15-1.56; P<.001) than those with fewer ANC visits, respectively. Furthermore, the effects of delivery assisted by skilled birth attendants and receiving PNC within 48 hours of delivery on complementary feeding indicators were also statistically insignificant (P≥.05).

Conclusions: Maternal use of the CoC appears to be effective in improving MDD and MAD among children aged 6 to 23 months in Bangladesh. The findings highlight the pivotal role of recommended ANC visits in promoting complementary feeding practices and further suggest opportunities to amplify the impact of CoC on timely ISSSF and MMF.