Household food security and infant feeding practices in rural Bangladesh

Objective To determine the association between household food security and infant complementary feeding practices in rural Bangladesh. Design Prospective, cohort study using structured home interviews during pregnancy and 3 and 9 months after delivery. We used two indicators of household food security at 3-months' follow-up: maternal Food Composition Score (FCS), calculated via the World Food Programme method, and an HHFS index created from an eleven-item food security questionnaire. Infant feeding practices were characterized using WHO definitions. Setting Two rural sub-districts of Kishoreganj, Bangladesh. Subjects Mother-child dyads (n 2073) who completed the 9-months' follow-up. Results Complementary feeding was initiated at age 4 months for 7 %, at 5-6 months for 49 % and at 7 months for 44 % of infants. Based on 24 h dietary recall, 98 % of infants were still breast-feeding at age 9 months, and 16 % received 4 food groups and 4 meals (minimally acceptable diet) in addition to breast milk. Mothers' diet was more diverse than infants'. The odds of receiving a minimally acceptable diet for infants living in most food-secure households were three times those for infants living in least food-secure households (adjusted OR=30; 95 % CI 21, 43). Socio-economic status, maternal age, literacy, parity and infant sex were not associated with infant diet. Conclusions HHFS and maternal FCS were significant predictors of subsequent infant feeding practices. Nevertheless, even the more food-secure households had poor infant diet. Interventions aimed at improving infant nutritional status need to focus on both complementary food provision and education.