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Abstract
Objective This study aimed to assess the status of infant and young child feeding (IYCF) practices and associated factors among children aged 0–23 months in the low-income regions of Dhaka City, Bangladesh.
Design A community-based cross-sectional study.
Settings Low-income regions of Dhaka City, Bangladesh.
Participants 530 children aged 0–23 months and their mothers.
Primary and secondary outcome measures Prevailing IYCF practices were assessed against the 17 indicators of IYCF recommended by the WHO/UNICEF in 2021. Modified Poisson regression models were built to explore the relation between socio-demographic variables and each of the selected IYCF indicators (early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)).
Results More than two-thirds of the children were reported to follow appropriate breastfeeding practices (EIBF, 70.4% and EBF, 60.9%). Among the complementary feeding indicators, almost half of the children (48.8%) were reported to meet MMF; however, only about 26% of the children reportedly met the MDD with a consequent low prevalence (22.9%) of the composite indicator MAD. More than half (55%) of the children were reported to consume egg and/or flesh food consumption; still, inappropriate dietary practices were observed among 60% had unhealthy food consumption, and 56% had zero vegetable or fruit consumption). Child age was a significant determinant of IYCF practices. The children of mothers with no pregnancy complications exhibited a greater chance of having EIBF (estimate: 1.21, 95% CI: 1.04, 1.42, p=0.02), MDD (Estimate: 1.67, 95% CI: 1.09, 2.55, p=0.02), and MAD (estimate: 1.70, 95% CI: 1.04, 2.77, p=0.03) compared with the children of mothers with pregnancy complications. The children with a mother having secondary or higher education had a higher chance of having MDD (estimate: 1.93, 95% CI: 1.35, 2.76, p=0.003) and MMF (estimate: 1.27, 95% CI: 1.03, 1.56, p=0.02) than the children of mothers having primary or no education. Similarly, children from higher-income households had a higher chance of getting MDD (estimate: 1.57, 95% CI: 1.07, 2.03, p=0.02), and MAD (estimate: 1.73, 95% CI: 1.14, 2.64, p=0.01) compared with children from lower-income households.
Conclusion IYCF practices among a considerable proportion of children aged 0–23 months in the low-income regions of Dhaka City were found to be suboptimal and predicted by children’s age, maternal education and pregnancy complications, and household income.
- NUTRITION & DIETETICS
- PUBLIC HEALTH
- Nursing Care
- Community child health
Data availability statement
Data are available upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Strengths and limitations of this study
The study used the 2021 WHO/UNICEF guidelines for assessing infant and young child feeding (IYCF) practices, ensuring standardised evaluation and comparability with global research.
The study targeted low-income urban communities in Dhaka, providing valuable insights into IYCF practices in underprivileged settings, where nutrition-related disparities are prominent.
The study assessed multiple indicators of IYCF, including breastfeeding initiation, complementary feeding practices and dietary diversity, offering a holistic view of child nutrition in the study area.
The study employed multivariate Poisson regression to analyse sociodemographic determinants of IYCF, allowing for a more robust understanding of factors influencing feeding practices.
The cross-sectional study design prevents establishing causal relationships, and the findings might have limited generalisability due to the inclusion of participants from only two locations in Dhaka and the use of convenience sampling instead of random sampling.
Introduction
The health, development and nutritional status of children under 2 years old are substantially affected by infant and young child feeding (IYCF) practices.1–4 Thus, it is essential to promote appropriate IYCF practices for children during this critical window of life to ensure adequate nutrition and, thereby, promote growth and development, prevent growth faltering and extend the survival of the children.1 3 4 Evidence shows that appropriate breastfeeding and adequate complementary feeding to children can substantially reduce the risk of under-five mortality.4 Hence, improving child feeding practices has become a major global priority, particularly for children under the age of two.5
Indicators were developed by the WHO in 2008 to evaluate IYCF practices in children ages 0 to 23 months.6 The 2008 IYCF indicator definitions were updated in 2021, and a few new indicators were added.5 The main recommendations are to start breastfeeding as soon as possible (within an hour of birth), to breastfeed exclusively for the first 6 months (exclusive breastfeeding (EBF)), to continue breastfeeding for up to 2 years (CBF) and to introduce safe and nourishing complementary food at 6 months of age. The updated guideline modified the definitions of the minimum dietary diversity (MDD), minimum acceptable diet (MAD) and minimum meal frequency (MMF). For example, in the past, MDD was calculated using data from the preceding 24 hour consumption of ≥4 of the seven food groups. Breast milk has been added as the eighth food group in the revised MDD criteria, and the cut-off point has been raised to ≥5 out of 8 food groups.6 MAD, characterised as a diet with MDD and MMF, must be followed at all times.5 Additional indicators have been included by the WHO and UNICEF recently. These include whether the child was fed mixed milk before 6 months if they ate eggs and/or flesh, if they didn’t eat any fruits or vegetables, if they drank sugary drinks or if they ate unhealthy meals.5
IYCF practices are suboptimal all over the world, with developing countries being particularly known for their common practices of feeding infants from bottles, starting breastfeeding later than is recommended, introducing optimal complementary foods either early or late, and providing low-quality, unhygienic complementary foods in large quantities.7–11 In Bangladesh, the coverage of appropriate breastfeeding and age-specific complementary feeding practices increased over the decades.12–14 However, the IYCF practices are still inadequate, particularly in rural and urban slum areas, and are probably one of the main reasons behind undernutrition.15 In the urban slums, only half (49%) of the children aged 0–5 months were exclusively breastfed, whereas the national prevalence was 56.2%.15 Similarly, the coverage of adequate MDD (42%), MMF (61%) and MAD (26%) were poor in these unprivileged areas.15 Hence, the high proportions of stunting (28%), wasting (10%) and underweight (28%) among children of 0–59 months are a continuing reality in the urban slums of Bangladesh.14
Although several studies have assessed IYCF practices in Bangladesh, most of them relied on the 2008 WHO/UNICEF IYCF indicators. However, research evaluating IYCF practices based on the revised definitions of key indicators, such as MDD and MAD, and new measures like Unhealthy Food Consumption (UFC) and Zero Vegetable or Fruit Consumption (ZVF) remains scarce, especially in Bangladesh. To our knowledge, only a limited number of studies have incorporated these revised indicators, and those that did either used older datasets10 15 or focused on specific subsets of IYCF indicators rather than providing a comprehensive assessment.
Furthermore, existing studies primarily rely on national survey data, which may not fully capture the unique challenges of urban low-income populations. The feeding practices of children in urban slums and low-income communities in Dhaka remain underexplored despite the high prevalence of child undernutrition and food insecurity in these areas. Our study addresses this critical gap by conducting a community-based cross-sectional study in low-income settings of Dhaka, assessing all 17 IYCF indicators using the latest WHO/UNICEF guidelines.
By identifying key sociodemographic determinants of feeding practices, such as maternal education, pregnancy complications, and household income, this study provides context-specific evidence that can inform targeted interventions and policy decisions. The findings contribute new knowledge to the field by demonstrating how socioeconomic disparities impact adherence to updated IYCF recommendations, offering more precise insights for programme and policy interventions aimed at improving child nutrition in resource-limited urban settings.
Methods
Study design and setting
A community-based cross-sectional study was conducted from October to December 2023 among children aged 0–23 months to explore IYCF practices and their socio-demographic determinants. The children were from low-income settings in Hazaribagh and Mohammadpur thanas (police stations) (except Geneva camp) of Dhaka south and north city corporations, Bangladesh (online supplemental figure 1). This low-income group maintains livelihoods as day labourers, rickshaw pullers, owners of small-size self-businesses or other low-salaried workers (eg, garment employees). According to the slum census 2014, the number of slums found in Dhaka was 3394 (1639 in Dhaka North City Corporation and 1755 in Dhaka South City Corporation).16 There was a total of 175 931 residences in the slum location of Dhaka City, and 646 675 people lived there (61 320 of them were children between the ages of 0 and 4 years). According to the census report, about 30.5% of the slum’s households were pucca or semi-pucca. A pucca house is a well-built, durable structure made with permanent materials such as brick or concrete for the walls, and reinforced concrete (RCC), cement sheets or tiles for the roof. The floors are typically made of concrete, tiles or stone. A semi-pucca house is a partially durable structure that combines both permanent and temporary materials. While its walls are often made of brick or concrete, it may also contain bamboo or mud components. The roof is usually constructed with corrugated tin, asbestos sheets or a mix of RCC and tin, while the floors can be made of mud, brick or concrete. Samples for this study were limited to households with pucca or semi-pucca in nature. 5226 pucca/semi-pucca households in total (1412 in Hazaribagh and 3814 in Mohammadpur thana) were accounted for in the study location. In the research areas, 19 180 people were living in households with an average size of 3.67. We assumed that the total number of 0–23 month-old children in the study area is 725 (the proportion of under-24-month-old children was 3.78%).16
Supplemental material
Sample size and sampling technique
The study population consisted of mothers and their children aged 0–23 months from low-income settings in Dhaka city. The sample size was calculated using the formula n==100 + 50i, where i represents the number of independent variables included in the final regression model.17 Based on the previous studies, it was assumed that the model would contain eight independent variables. Thus, the minimum required sample size was determined to be 500 using the above formula. To accommodate potential errors during the study, an additional 5% was included, bringing the final sample size to 525 participants. We approached 568 mothers, and a total of 38 mothers refused to be a part of the study. Finally, a total of 530 participants were included in the study. We conveniently surveyed 530 children and their mothers for this study.
Inclusion and exclusion criteria
Several inclusion and exclusion criteria were considered during the selection of study participants. The participants were considered eligible for the study based on the following characteristics:
Families with a child aged 0–23 months.
Families resided in low-income areas of Dhaka City for at least 6 months prior to data collection.
Caregivers who provide informed consent to participate in the study.
The participants were excluded when they were found to meet the following exclusion criteria:
Children outside the age range of 0–23 months.
Families who have lived in low-income areas of Dhaka City for less than 6 months prior to data collection.
Children diagnosed with severe illnesses, congenital disorders or chronic conditions (eg, cerebral palsy, congenital heart disease) that significantly affect feeding practices.
Children who are hospitalised or receiving critical care at the time of data collection.
Cases where the primary caregiver is absent, unavailable or unable to recall feeding practices due to cognitive impairment, mental illness or other conditions.
Refusal to provide informed consent for participation.
Data collection
Face-to-face interviews were conducted with 530 mothers having children aged below 2 years in low-income settings in selected areas. A structured questionnaire comprising different sections (eg, socio-demographic and socio-economic information, maternal background and health service-related information, and IYCF-related information) was prepared (online supplemental file 1). The enumerators were exhaustively trained in data collection for 2 days. A pilot study was conducted to evaluate the efficiency of the enumerators, and required changes were made to the questionnaire based on the pilot study. The final questionnaire was translated into Bengali, and the eligible enumerators were recruited for the final data collection.
Supplemental material
Outcome variables
To assess IYCF practices, we used all the indicators of IYCF practices recommended by the WHO/UNICEF in 2021.5 For the analysis of associated background factors of IYCF, five indicators were used. These indicators were EIBF, EBF, MDD, MMF and MAD. EIBF was measured by asking the respondent about how long after birth the child was fed only breast milk rather than any other foods. The other four indicators were recorded using information about foods given to the child in the last 24 hours before the interview according to the definition of IYCF indicators guidelines.5 The definition of all the indicators of IYCF are given in online supplemental table 1.
Supplemental material
EIBF: percentage of children born in the last 24 months who were put to the breast within 1 hour of birth.
EBF: percentage of infants aged 0–5 months who were fed exclusively with breast milk during the previous day.
MDD: percentage of children aged 6–23 months who consumed foods and beverages from at least five out of eight defined food groups during the previous day.
MMF: percentage of children aged 6–23 months who consumed solid, semi-solid or soft foods (but also including milk feeds for non-breastfed children) the minimum number of times or more during the previous day.
MAD: percentage of children aged 6–23 months who consumed a minimum acceptable diet during the previous day.
Independent variables
Child, maternal and household-level variables were selected based on previously published studies as independent variables.10 11 18–21 Child-related variables included the age of the child (0–5 months, 6–11 months, 12–17 months and 18–23 months) and their sex (male and female). Maternal variables included age (15–19 years, 20–30 years and 31–41 years), educational level (‘primary or below’ and ‘secondary or higher’), maternal occupation (homemaker, others (garment workers/day labourers), nutritional status (underweight, normal and overweight) and pregnancy-related complications of the mothers (yes, no). The pregnancy-related complications included gestational diabetes, hypertension, anaemia and asthma. Household size (≤4 members and ≥5 members), monthly income (low (Bangladeshi Taka (BDT) ≤13 500), high (BDT >13 500)) and food security status (food secure and food insecure) were used as household-level variables. Household food insecurity was assessed using the Household Food Insecurity Access Scale guideline (version 3).22 The definition of all the independent variables is given in online supplemental table 2.
Statistical analysis
IYCF practices and other maternal and child individual and household-level background characteristics were summarised as frequencies and percentages. A X2 test was run to find the association between five IYCF indicators and other individual and household-level background characteristics. We used Poisson regression to estimate the associations between the predictor variables and the outcome variables (EIBF, EBF, MDD, MMF and MAD). Although Poisson regression is typically used for count data, we employed a modified Poisson approach to obtain risk ratios when modelling a binary outcome. To account for potential violations of the equidispersion assumption (ie, when the variance does not equal the mean) and to correct for heteroskedasticity, we computed robust standard errors using the sandwich estimator. This method provides valid inference by adjusting the variance estimates, thereby yielding reliable CIs and p values for the risk ratios. All analyses were conducted in R (version 4.4.1) using the glm function with a Poisson family specification and the sandwich and lmtest packages for robust variance estimation.
Regression model building
The indicators of IYCF were binary variables: early initiation of breastfeeding, EIBF (within the first hour of birth, after 1 hour of birth), exclusive breastfeeding, EBF (yes, no), MDD (adequate, inadequate), MMF (yes, no) and MAD (yes, no). Five separate Poisson regression models were built to find the relation between socio-demographic variables with each of the five indicators of IYCF. Variables with significant associations at p value <0.25 in bivariate analyses were considered for inclusion in the regression models.23 Before constructing the final Poisson regression model, the underlying assumptions were evaluated. Multicollinearity was assessed using the variance inflation factor (VIF), with a VIF value exceeding two considered indicative of multicollinearity. A p value <0.05 was used to determine whether a variable was statistically significant. The association was reported as a risk estimate with a 95% CI.
Patient and public involvement
Patients and the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Results
Sociodemographic characteristics of children
The sociodemographic characteristics of children 0–23 months of age are presented in table 1. About one-quarter (25.1%) of the children were below 6 months of age, 30% were 6–11 months and others were between 12 and 23 months. The percentage of male (51.1%) and female (48.5%) children was almost equal. Most of the mothers of the children were homemakers (85.8%) and fell between 20 and 30 years of age. Only 43% of the mothers reported having completed secondary or higher education. More than half of the mothers had a normal nutritional status (56.2%), while 11.5% were underweight. Overweight was prevalent among almost one-third (32.3%) of the mothers. About one-fourth of the mothers (23.2%) had pregnancy complications. Only about 21.3% of the children were from food-secured families.
Socio-demographic characteristics of the children aged 0–23 months
IYCF practices
About 70.4% of the children reportedly experienced early initiation of breastfeeding, while 60.9% had exclusive breastfeeding up to 6 months (figure 1). More than three-fourths of the children (78%) were introduced to solid, semi-solid or soft foods at 6–8 months. Only about one-fourth of the children aged 6–23 months had MDD (26.2%) and less than half of them had MMF (46.9%) and MMFF (48.8%) (figure 1). On the other hand, only 22.9% of the children had a MAD. About 55% of the children had egg and/or flesh food consumption (EFF), while about 60% had UFC, and 56% had ZVF.
Coverage of infant and young child feeding practices among the children of urban slum areas.
Infant feeding area graphs
The area graph of feeding practices of the children under 6 months of age is provided in online supplemental figure 2. The percentage of EBF decreased with the increase in the age of the children (from 84.6% at 0–1 months to 49.2% at 4–5 months). On the other hand, the percentage of non-breastfeeding (0 to 4.8%), breastfeeding and solid or semi-solid food feeding (0 to 7.9%) slightly increased with the age of the children. The percentage of breastfeeding and non-milk liquids was higher at 2–3 months, which was lower in the early months and at 4–5 months. However, the percentage of breastfeeding and animal milk or formula feeding was lower at 2–3 months and higher at 4–5 months.
Food group consumption among the children aged 6–23 months
Most of the children were breastfed (89.9%) and fed cereals, starch and tubers (82.4%) (figure 2). About one-third of them were fed with legumes, nuts and seeds (35.5%); fish and meat (32.7%); and other fruits and vegetables (30.5%). However, a lower percentage of children were fed eggs (28.7%), dairy products (28.5%) and vitamin A-rich fruits and vegetables (18.6%).
Different food group consumption and minimum dietary diversity among the children aged 6–24 months.
Sociodemographic determinants of breastfeeding practices
Early commencement of breastfeeding was significantly associated with children’s ages, mothers’ nutritional status and maternal pregnancy problems (table 2). Compared with children aged 0–1 months, those aged 12–17 months had a 19% lower chance (Estimate: 0.81, 95% CI: 0.69, 0.96, p=0.02) of initiating breastfeeding on time. The children of normal and overweight mothers had less chance of having EIBF compared with the children of underweight mothers (table 2). The children of mothers with no pregnancy complications had a 21% higher chance (Estimate: 1.21, 95% CI: 1.04, 1.42, p=0.02) of having EIBF compared with the children from mothers with pregnancy complications. On the contrary, a decreasing trend was found in exclusive breastfeeding with an increase in age (table 2). However, the sex of the children, household income and household food insecurity had no significant associations with the EIBF and EBF.
Socio-demographic determinants of early initiation of breastfeeding and exclusive breastfeeding among children
Socio-demographic determinants of MDD
Children’s age, maternal education, household income and maternal complications during pregnancy all demonstrated a significant relationship with MDD (table 3). Children aged 12–17 months had a 138% higher chance (estimate: 2.38, 95% CI: 1.51, 3.75, p=0.002) of having MDD compared with children 6–11 months. Similarly, children aged 18–23 months had a 155% higher chance (estimate: 2.55, 95% CI: 1.62, 4.02, p<0.001) of having MDD compared with children 6–11 months. Children with a mother who had a secondary or higher education had a 93% more chance (estimate: 1.93, 95% CI: 1.35, 2.76, p=0.003) to have MDD than children with mothers having primary or no education (table 3). Similarly, children from high-income households had a 57% higher chance (estimate: 1.57, 95% CI: 1.07, 2.03, p=0.02) of getting MDD than children from lower-income households. Children with mothers without pregnancy difficulties had a 67% higher chance of getting MDD (estimate: 1.67, 95% CI: 1.09, 2.55, p=0.02) than children with mothers with pregnancy complications. However, the father’s occupation, the mother’s nutritional status and household food insecurity had no significant associations with the MDD of the children.
Socio-demographic determinants of minimum dietary diversity, minimum meal frequency and minimum acceptable diet among children aged 6–23 months
Socio-demographic determinants of MMF
The MMF of children aged 6–23 months was significantly affected by maternal educational level, household income and the children’s age (table 3). Children aged 12–17 months had a 92% higher chance (estimate: 1.92, 95% CI: 1.47, 2.50, p<0.001) of having MMF compared with children 6–11 months. Similarly, children aged 18–23 months had a 56% higher chance (estimate: 1.56, 95% CI: 1.17, 2.08, p=0.002) of having MMF compared with children aged 6–11 months. Children with a mother who had a secondary or higher education had a 27% more chance (estimate: 1.27, 95% CI: 1.03, 1.56, p=0.02) to have MMF than children with mothers having primary or no education (table 3). Similarly, children from high-income households had a 30% higher chance (estimate: 1.30, 95% CI: 1.03, 1.65, p=0.03) of getting MMF than children from lower-income households. However, the children’s sex, maternal age, father’s occupation, household size and household food insecurity had no significant associations with the MMF.
Socio-demographic determinants of MAD
The age of the children, maternal age, household income and maternal pregnancy complications were significant determinants of the MAD (table 3). Compared with children aged 6–11 months, children aged 12–17 months had a 185% higher chance (Estimate: 2.85, 95% CI: 1.69, 4.80, p<0.001), and children aged 18–23 months had a 169% higher chance (Estimate: 2.69, 95 CI: 1.61, 4.51, p<0.001) of having MAD. An increasing trend was found in MAD with an increase in maternal age. Similarly, children from higher-income households had a 73% higher chance (Estimate: 1.73, 95% CI: 1.14, 2.64, p=0.01) of getting MAD compared with children from lower-income households. Children with mothers with no pregnancy complications had a 70% higher chance (Estimate: 1.70, 95% CI: 1.04, 2.77, p=0.03) of having MAD compared with the children with mothers with pregnancy complications. However, other variables, such as maternal education, maternal occupation, father’s occupation, household size and household food insecurity had no significant associations with the MAD.
Discussion
The present study explored the current situation of feeding practices of children under the age of two in low-income settings in Dhaka, Bangladesh, using the latest recommendations by the WHO/UNICEF.5 While early initiation and exclusive breastfeeding rates indicate moderate adherence to recommended practices, the adequacy of complementary feeding remains a concern. A significant proportion of children do not receive a diverse diet or the minimum required meal frequency, leading to suboptimal nutrition. Child age was a key determinant of feeding practices, while maternal factors such as pregnancy complications negatively impacted appropriate feeding. Conversely, higher maternal education and household income were associated with improved adherence to recommended feeding practices.
Although Bangladesh has made remarkable improvements in reducing undernourishment prevalence among children under 5 years of age, the feeding practices of the children are still inadequate both in urban and rural areas.12–14 In our study, the prevalence of EIBF was 70.4%, which is higher than the national prevalence (46.6%)14 and close to a previous study in slum areas (64.2%).24 Another recent study found the highest prevalence of EIBF in slum areas (44.9%).15 According to the MICS-2019, the prevalence of EIBF is likewise highest (59.5%) among the poorest and lowest (35.8%) among the richest.14 In the population with low income, the high EIBF rate can be the result of standard delivery procedures rather than caesarean sections. Compared with mothers who had vaginal deliveries, mothers who had caesarean sections were less likely to start breastfeeding at early stages.21 Although a higher national prevalence of EBF (65%) was observed in 2017–2018 in Bangladesh, by 2022 it had dropped to 55%.25 The EBF rate of this study was higher than the national prevalence. However, the previous two studies reported that the EBF rate was lower in slum areas.15 24 According to a recent study using data from the 2014 Bangladesh Urban Health Survey, housewife mothers and those with a lack of education are more inclined to exclusively breastfeed.26 Owing to the low-income groups in the study population, acute household food insecurity and the working mother’s job loss due to COVID-19 could be additional potential factors for more EBF.27 However, the prevalence of exclusive breastfeeding declined as children’s ages increased, as followed by a national report.25
Introducing firm, semi-solid or soft foods between the ages of 6 and 8 months is associated with a decreased risk of stunting and underweight.28 We noticed that compared with the 87.9% of children in a previous study conducted in a slum,15 78% of children aged 6 to 8 months had consumed solid, semi-solid or soft foods the day before. According to new WHO/UNICEF guidelines, only about one-fourth of the young children in the current study meet the MDD, which is less than the recent national survey (39%).25 This value was also lower than the previous study conducted in slums (36.4%), but higher than the previous study conducted in rural Bangladesh.10 The prevalence of MMF is comparable to recent national reports (61%)25 and studies conducted in low-income regions (60.7%).15 However, the figure is less than a national survey, where they reported that around 81% of children had received the recommended amount of food.13 Just 22.9% of children comply with the MAD, which is less than the previous study in a slum (25.9%),15 and the most recent national survey (29.9%).25 Thus, nearly three-fourths of poor urban children are not getting age-appropriate diets to meet their nutritional needs and to achieve optimum growth and development. Evidence suggests that such improper practices in child diets adversely affect their health and nutritional status.29 30
More than half of the children in the current research reported consuming egg and/or meat food on the previous day, which is more than twice as many as in the prior study conducted in a rural Bangladeshi community.10 That is one of the newly added IYCF indicators. The other two new indications of IYCF are the consumption of sweet beverages (SWB) and UFC. Sweetened beverages or drinks don’t offer any extra nutrition, except energy. Consumption of sugary foods and drinks elevates your likelihood of dental cavities and childhood obesity.31 Consumption of unhealthy foods such as chocolate, candies, chips, cakes, cookies and French fries should be restricted because they substitute and reduce the intake of foods high in nutrients. The prevalence of both SWB and UFC consumption was higher in this study as compared with the national figure; they reported 32% and 49%, respectively.25 According to the WHO, consuming fewer fruits and vegetables increases the risk of non-communicable illnesses.5 In a low-income setting, over 50% of study participants aged 6–23 months did not consume any fruits or vegetables over the preceding 24 hours, and the finding is lower than in an earlier study.10
The present study found household income, a contributing factor to higher coverage of age-specific appropriate dietary practices of the children under 2 years of age in low-income regions of Dhaka. The national surveys13 14 and previous studies11 19 20 32 also confirmed that the prevalence of proper child-feeding practices increased with the household income quintiles and food security. Parents with higher income have more access to healthy dietary choices for themselves and their children, which might contribute to appropriate IYCF practices of their children. Such poorer segments of Bangladesh like Dhaka City could be brought under appropriate policy actions along with creating more income opportunities, giving incentives to the families having infants to improve the dietary practices of the children for optimal growth. Moreover, children between the ages of 6 and 11 months and 12 to 17 months had a 75% and 13% lower likelihood of meeting MDD, respectively, compared with the older age group, which is consistent with the previous studies conducted in Bangladesh.10 25 33
The educational level of the parents and caregivers can play an important role in the execution of proper childcare, breastfeeding practices and adequate dietary practices for their children. The current study indicates that mothers who achieved a secondary or higher level of education are more inclined to provide their children with MDD, MMF and MAD, as opposed to mothers with none or less than a primary level of schooling. Previous studies also highlighted the role of mothers’ higher education level on their children’s appropriate IYCF practices.10 11 19 20 32 The educated mothers might have adequate knowledge regarding the ways and importance of proper childcare and IYCF practices. Such awareness might have a positive influence on their children’s optimal breastfeeding and dietary practices. Thus, priorities could be given to women’s education, and appropriate counselling of the mothers and caregivers regarding child healthcare and IYCF practices is required.
Furthermore, the current study found that children of mothers with no pregnancy difficulties were more likely to have an early start of breastfeeding, MDD and MAD than children of mothers with pregnancy complications. This finding is consistent with previous studies that concluded that infants born by caesarean section or with other pregnancy complications had a lower likelihood of early beginning breastfeeding when compared with those who were born vaginally and without any complications.34–36 This result can be explained by the fact that the odds of initiating breastfeeding early are lowered after caesarean section birth or complicated birth due to several factors, including the prolonged separation of the mother and her child, surgical complications like the effects of anaesthesia and weariness or stress from difficult labour or other birth complications.
In the present study, we found no significant effect of the sex of the children, maternal occupation, father’s occupation and household size on the proper breastfeeding and complementary feeding practices of the children. Similarly, a study among 80 low- and middle-income countries found no consistent differences between boys and girls in terms of three complementary feeding practices (MDD, MMF and MAD).37 However, another previous study reported that female children are more likely to be fed properly compared with the male.10 Although children from small families had more chances of having proper breastfeeding and complementary feeding, we did not find any difference in our study. Similar findings were mentioned by Jubayer et al.10 The occupation of the father and mother might also contribute to the proper feeding practices of their children through the allocation of resources and income and the assurance of food security and care.
Strengths and limitations of the study
This study has several strengths. Primarily, the study used the 2021 WHO/UNICEF guidelines for assessing Infant and Young Child Feeding (IYCF) practices, ensuring standardised evaluation and comparability with global research. Second, the study targeted low-income urban communities in Dhaka, providing valuable insights into IYCF practices in underprivileged settings where nutrition-related disparities are prominent. Moreover, the study assessed multiple indicators of IYCF, including breastfeeding initiation, complementary feeding practices and dietary diversity, offering a holistic view of child nutrition in the study area. The study also employed multivariate Poisson regression to analyse sociodemographic determinants of IYCF, allowing for a more robust understanding of the factors influencing feeding practices. However, there are also several limitations to consider. The cross-sectional design of the study restricts our ability to infer causality, as the data capture a single moment in time, making it challenging to determine the directionality of associations. Additionally, the relatively small sample size for certain IYCF indicators may have reduced the statistical power, potentially limiting the detection of significant associations. Lastly, the findings may have limited generalisability due to the recruitment of participants from only two locations in Dhaka and the reliance on convenience sampling rather than a randomised approach.
Implication of the study findings
This study examined IYCF practices among children aged 0–23 months in low-income areas of Dhaka, Bangladesh, revealing low adherence to recommended practices, particularly in breastfeeding, MDD and MAD. Maternal education and household income were key determinants influencing these practices, with children from lower-income households and mothers with limited education being less likely to meet IYCF recommendations. These findings highlight the need for targeted interventions, including community-based nutrition education programmes tailored for low-income households and caregivers with limited formal education, focusing on practical strategies to improve breastfeeding and complementary feeding using locally available, nutrient-dense foods. Additionally, economic support programmes, such as conditional cash transfers linked to participation in nutrition education or healthcare visits, could enhance IYCF adherence. Integrating IYCF counselling into routine maternal and child health services and strengthening community-based interventions by engaging local health workers and peer support groups could further reinforce positive feeding practices. At the policy level, improving access to affordable, nutrient-rich complementary foods through food fortification and market-based interventions, along with gender-sensitive approaches such as vocational training and microfinance initiatives for mothers, could help improve household food security and dietary choices. Implementing these targeted strategies can enhance IYCF practices and contribute to better nutritional outcomes for children under two in low-income settings.
Conclusion
The study highlighted low coverage of appropriate breastfeeding and complementary feeding practices among children from low-income regions of Dhaka City. Although EIBF and EBF were comparatively higher, the practice of MDD, MMF and MAD was inappropriate in most cases. Child age was a significant determinant of different indicators of IYCF practices. Mothers’ pregnancy complications hurt the coverage of age-appropriate feeding practices for their children. On the contrary, mothers’ higher education and household income were significant determinants of higher coverage of proper IYCF practices. Improving appropriate IYCF practice may be accomplished by providing mothers or primary caregivers with high-quality counselling, with a focus on illiterate women. Moreover, giving economic support or other effective incentives might be another contributing factor in the higher coverage of appropriate feeding practices for children under 2 years of age.
Data availability statement
Data are available upon reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants. The nature and goal of the study were thoroughly explained to the parents of the children before the interview. Both oral and written informed consent were obtained from the mother/father of each study participant. Ethical approval for the study was obtained from the Institutional Review Board of the Faculty of Biological Sciences, University of Dhaka (Ref. No. 238/Biol. Scs). Participants gave informed consent to participate in the study before taking part.
Footnotes
Contributors TT and KMRK conceived and designed the experiments, performed the experiments, analysed and interpreted the data, wrote the paper and approved the final version. MHI analysed and interpreted the data, wrote the paper and approved the final version. AAMK and SI analysed and interpreted the data, wrote the paper and approved the final version. SS conceived and designed the experiments, performed the experiments, wrote the paper and approved the final version. KMRK (corresponding author) is responsible for the overall content as the guarantor.
Funding Special thanks to the University Grant Commission (UGC), Bangladesh for the research grant (2022-23) to public university teachers.
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Competing interests None declared.
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