COMPLIMENTARY FEEDING PRACTICES IN RELATION TO

NUTRITIONAL STATUSOF CHILDREN AGED 6-24 MONTHS

IN KISII LEVEL 5 HOSPITAL
NAME :
DOREEN KEMUNTO RACHAMI
FACULTY : PUBLIC HEALTH
DEPARTMENT : COMMUNITY NUTRITION
COLLEGE : KENYA MEDICAL TRAINING COLLEGE KAREN CAMPUS

A DISSERATION SUBMITTED AS A
PARTIAL FULFILMENT FOR AWARD OF THE
DIPLOMA IN COMMUNITY NUTRITION.
YEAR OF STUDY :THIRD YEAR.
DURATION
: 2011-2014

TITTLE: COMPEMENTARY FEEDING PRACTICES IN RELATION TO NUTRITIONAL STATUS

OF CHILDREN AGED 6-24 MONTHS IN KISII LEVAL 5 HOSPITAL (KLSH)
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND INFORMATION
Complementary feeding is the gradual introduction of solid food into the body's diet to
supplementary breast milk which still forms part of the diet. The caregiver should be advices not to
give the baby solid /liquid food before 6 months old. This is because the digestive system is not fully
developed to coup with solid food but by the end of 6 months all babies should be introduced to aimed
diet with proximity (burgers at al 2006).
Complementary food include special traditional food that are prepared especially for the infant
and increasing the amount & texture as the baby grows older, same food that are consumed by other
family members (escort at al 2003)
inappropriate feeding practices are major causes of malnutrition in children under 5 years who
era not breastfed exclusively and are prone to infections, grow slowly and are likely to die young than
those breastfed exclusively. (WHO 2004)
Low quality complementary food combined with inappropriate feeding practices for the
children under 2 years in developing countries are at risk of under-nutrition and its outcome may be due
to early or late introduction of solid, semi- solid or soft foods. (SCN 2008)
The first 2 years of child's life are bieng marked by high growth rate and intense malnutrition.
Optimum nutrition and good infant feeding are among the most important determinants of health
growth and development. Therefore appropriate infant feeding including breastmilk and
complementary feeding practices are fundermental to child's nutritianal health and surviaval during this
period. (USAID, 2010)
Older babies and ypung children need food other than breastmilk for the following reasons, For
nutrition grow and develop in a healthy condition & to accustom to the eating habits of the family.
(Gabrielle palmer 2009)
inaoproprate complementary feeding practices I.e poor quality and sufficient quality of
complementary foods have been identified as major causes of malnutrition in young children (bhandori
N. et al, 2006.)
1.2 PROBLEM STATEMENT.
Childhood malnutrition remains a wide spread problem in the developing world. Over 50 million
children under 5 years of age in the developing world were wasted, 27% of children were underweight
and 32% were stunted (UNICEF, 2008) . Malnutrition`is associated with childhood deaths, infections
and disease as wel as children's delayed mental and motor development (law G, 2005).
Nutritional needs for growth and development between 6-24 months of age are greater per kg of body
weight than any other time of life . growth jattering occurs mainly in the first 2 years of life in all
regions of life. Insufficient nutrient intake and illness resulting from the introduction of pathogens in
contaminated food and feeding bottles are major causes of malnutrition.
Good nutrition is essential at this time to ensure healthy body development in order to prevent long
term, irresistible consequences. Poor feeding practices and low quality food can affect the future
learning abilities, economic productivity, immune response and reproductive outcome, children who
are undernourished before they reach their second birthday and later gain weight rapidly after the two
years are at high risk of nutrition related chronic diseases as adults (WHO 2006)

Reducing malnutrition among children below 6 months is crucial in achieving MGDS which are
concerned in hunger reduction, undernutrition, child death and maternal mortality (SCN, 2007)
1.3 JUSTIFICATION
Malnutrition is common during the period of 6 -24 months than in the first 6 months of life
because families may not be aware of infant needs and may not know how to prepare these
foods or food may not be available due to poverty hence not able to provide nutritious food.
Complementary feeding is one of the major determinants of growth and development in
children Its introduction to children is poor and unhygienic thus may lead to infections such
as diarrhea and malnutrition in children aged 6-24 months as complementary feeding and to
put measures that can be used to educate caregivers /mothers on effect of complementary
feeding on nutritional status. The research study will be carried out as a partial fulfillment
for award of diploma in community nutrition.
1.4 RESEACH QUESTIONS
What is the relationship between nutritional status of children aged 6-24 months and
complementary feeding in Kisii level 5 Hospital (KI5H).
1.5 RESEARCH OBJECTIVES
General objectives
1.5.1 To find out nutritional status of children aged 6-24 months on complementary feeding
at Kisii level 5 hospital (KL5H).
Specific objectives
1.5.2 to asses the social demographic characteristics of the respondents.
1.5.3 To assess child feeding practices
1.5.4 To find out socio-cultural practices related to complementary feeding among the
respondents.
1.5.2 To asses nutritional status of children
1.6 CONCEPTUAL FRAMEWORK
Figure 1.1

Hygiene and sanitation

Socio-demographic
Characteristics

NUTRITIONAL
STATUS

Feeding practices of children

Socio-cultural practices

Complementary feeding

CHAPTER TWO (II)

LITERATURE REVIEW
2.1 Introduction
Complimentary feeding ism defined as the period during which solid or liquid foods are provided along
with breast milk. Complimentary food is the term used to describe any nutrient containing food or
liquids. Other than breast milk that are given to young children during the period of complementary
feeding (FANTA 2005)
After 6 months, breastmilk alone is no longer sufficient to provide enough nutrients needed to
promote growth and development of the child. Complementary foods need to be the diet in addition to
breastfeeding (Molly Sam et al, 2006)
The timely introduction and provision of complimentary foods during infancy are necessary for both
nutritional and development reasons and enables transition frombreast milk feeding to family
foods.Additionally, complementary foods becomes important when feeding is not possible or when
breast milk can no longer meet micro and macro nutrients requirements as the infants gets older
(USAIDS, 2010)
After the period of exclusive breastfeeding, the diet undergoes a change, from a single food breast
milk to a variety of complementary foods plus breast milk, to meet infants nutritional
Requirements. This period is associated with not only increasing and changing nutrient requirements
but also with rapid growth, physiological malnutrition and development of the infant. Poor nutrition
during this criticalperiod of life may increase the risk of growth flattering and micro-nutrient
deficiencies and may have advanced effects on health and mental development, thus improved
complementary feeding practices at this period of life are among the most cost effective public health
tools (K.E Elizabth et al, 2007)
Comlementary food should be meeting the criteria of frequency adequacy, dense active feeding
(FADAF). Key issues that need to be addressed to improve complementary feeding practicesas
follows:- Inadequate knowledge, optimal complementary feeding practices by caregivers, unhygienic
preparation and storage of complementary foods, widespread use of nutritionally inadequate
complementary foods, especially cerials baesd porriage, low feeding frequency makes it especially
careal based porriage, low feeding frequency makesmakes it difficult to meet energy needs of infants
and young children. Limited access to appropriately fortified complementary foods, lack of standards
to meet regulate complementary foods, widespread promotion and use of inappropriate constituded
cereals and legume mixes. (MHS, 2010).
2.2 RECOMMENDATION FOR COMPLEMENTARY FEEDING.
Arecent review of current recommendation of complementary feeding revealed some similarities as
well as many differences, among national and international organizations. The similarities include the
need for a gradual trasnsition from soft foods to family foods, starting complementary feeding
sometimes between 4-6 months of age and introducing cereals first and avoiding offering cows milk

until 9-12 months of age. The differences include mention or lack of mention of the need for iron
fortified foods, specific vitamim, minerals supplements and the recommended number of meals.
( Guyon, 2005)
As a general rule, the nutrient of the young child deteriorates when complentary foods start to
subtitle for breast milk. Complementary feeding is poorly done in many developing countries due to
lack of information about what foods are appropriate, how much should be given, how they should be
given and their inadequacy and quality among other problems (Vitollo, 2006)
2.3 ESTIMATING THE AMOUNT OF NUTRIENT NEEDED IN COMPLEMENTARY FOODS.
The WHO report provide estimates of the amount of nutrients that should be consumed in
complementary foods. The approach used was to estimate the usual intake of each nutrient from breast
milk, for infants consuming low average and were calculated as the average reported volume of breast
milk consumed I developing countries and separately in developed countries and average values for
nutrient content of human milk. The nutrient intakes estimated in this way were then subtracted from
the recommended intakes for each nutrient that is needed for each nutrient producing an estimate of
the amount of each nutrinent that is needed from complementary foods. If desired, these values can be
modified by substitung country specific recommended nutrient composition data. It shouls be
emphasized that the above calculations were based on estimates of nutrient content of breast milk of
women in developed countries (except vit. A) Due to lack of inadequate information from developing
countries. This means that the contribution of breast milk to the infant intake of some nutrients as been
over- estimated, where maternal undernutrition has reduced breast milk content of these nutrients
(WHO, 2009)
2.4 Improving nutrient content of complementary foods.
2.4.1 Increasing energy intake:
It is difficult to interpret association between energy intake and growth. When energy intake from
foods is low, the intake of many other nutrients will also be inadequate. Experiments in which the
energy contents constant indicates that the energy deficiency affects growth in weight but not in height,
at least in the short term (adu-afarwuah 2006)
Energy density can be I ncreased by viscosity of cereals with amylases. This can be purchased
commerciallyor made by germinating local cereals. This strategyhas achieved mixed results. Although
amylase treated cereal porriage can be fed more expensive and take longer to prepare. They also carry a
higher risk of bacterial contamionation if home produced analyses are used. Amylase treated increase
energy intake in only 5 out of 8 studies. Concerns about the microbiological safety of foods treated
with amylase and the lack of clear efficiency of increasing energy intake suggest that extensive
promotion of amylase treatment approach is not justified at this time (Roy, 2005)
2.4.2 Increasing protein intake
In most situations, the protein intake of infants are adequate especially if they are consuming some
breast milk. Trials with infant formulas, revealed that changing energy intake, while holding protein
intake constant and adequate affected the weight (fatness) of infants rather than their linear growth

(WHO, 2004) situations that contribute to to a low protein intake are; low breast milk intake, use of low
protein.l Starchy staples such as cassava; over reliance on foods high in sugar and fats and low in food
intake in general (WHO,2004)
2.5 IMPROVING TH MICRIO-NUTRIENT CONTENT/QUALITY OF COMPLEMENTARY
FOODS
One strategy of improving the amount and bioavailability of micro-nutrients is to increase assumption
of animal products. Animal products are high in most micro-nutrients and vitamins are better absorbed
from meat, milk & eggs than they are from plants derived foods are unfortunately. Children from
developing countriesoften receive only small amounts of foods that contain animal products if any
(Luther, 2008)
There has been interest in improving the quality of complementary food by adding locally available
animal products as well as specific fruits and vegetables to the usual cereals, staples and legumes that
are fed to young children in developing countries. Ahigher intake of animal products has been
associated with better growth in some studies (adu- afarwlaah, 2007)
Due to their good acceptability by infants and children and their relatively low cost, milk products
have been provided to young children in order to improve the quality of their diet ( smuts, 2005)
2.6 Characteristics of good complementary feeds.
2.6.1Food square.
Should be rich in energy and nutrients, clean and safe, soft and easy to eat, easy for famiy to obtain and
also easy to prepare (ann Bugers et, 2006)
figure 2.1

Source : UNICEF, 2004.

2.6.2Practice Actieve Feeding
Children who are not actively encouraged to eat frequently are malnaurished. Practiced actieve
feeding by offering foods to encourage intake, experiment with different textures and colour
combination (AMREF, 2005)
caregivers should feed infants directly and healthy older children to feed, adequate time should be
allowed for feeding, talk to infants while feeding, minimize distractions during meals, mix poorly
accepted foods with favourite foods to encourage intake. Offer again within one hour. All children

should have their own bowls and food to ensure that the slower eating young children are not deprived
of food by other siblings. (My Health Portal, 2006)
2.6.3 Dangers of introducing compementary foods too early.
The child does not neeed food which may displace breast milk making the child to take less breast
milk and the mother's supply decreases hence disable to meet the childs needs (WHO, 2006)
2.6.4
danger of introducing complementary
foods too late.If the mother does not give compementary food after 6 months the boby
may stop gaining weight at a heakth rate and become underweight. It becomes more
difficult to persuade the baby to start eating solid foods at a late stage . Babies who do
not eat other foods may want nothing but breast milk other than any malnutrition.
(Tanushree Butt et al,2006)
2.6.5
child characteristics
age of the child has an influence on their nutritional status at the age of 6-24 months when the children
are growing rapidly and needs enough food with enough nutrients and energy , therefore any shortages
in food supplied hinders the normal growth .(AMREF,2005)
2.7 relationship between independent and dependent variable
2.7.1 Hygiene and sanitation practices.
A reliable water supply is a key component of good compementary feeding . This is not merely becouse
consistence supplies of water are essential for hygienic food preparation, hand washing after defecation
or cleaning a childs bottom and changing nappies. These practices are essential to reduce infections
risks which excerbarate under-nutrition (Kramer et al, 2007 ).
however ,scientifically sophisticated food staff, safe feeding cannot be achieved if hand washing and
other aspects of food hygien are contained through inadequate water provision.
A reliable water supply is a key component of good complimentary feeding.(Gabrielle Palmer, 2009)
2.7.2 social-cultural practices.
In many communities there are superstitions and beliefs concerning the effects of onather pregnancy on
the quality of breast milk. It is belived that the heat from the womb poisons the milk in the breast and
the baby in the womb is jelous of the older sibling on the breast. It is therefore considered urgent that
the child should be taken