Introduction

Sufficient nourishment is crucial for maintaining optimum health, which includes children's physical and mental development. [1]. A young child's specific nutritional and physiological demands are meant to be met by infant and young child feeding practices (IYCF). It is therefore generally advised that mother begin timely nursing and provide safe, supplementary food that is nutritionally enough by the time the child’s reaches month six. [2]. The first two years of life are recognized as the "window of opportunity" for ensuring survival, growth, and development, and IYCF practices are essential during this period. Breastfeeding and supplemental feeding are part of the IYCF practice, and they have a significant impact in a child's nutritional health. [3].

Exclusive breastfeeding (EBF) is the exclusive feeding of a newborn for the first six months of life; complementary feeding, which begins at 181 days of life and includes other nutrient-dense meals such cereals, dairy products, meat products, fruits, and vegetables, is the term used beyond this period. [4]. Breastfeeding for a full six months, together with an adequate supply of safe, suitable, nutritious solid, semi-solid, and soft food, all contribute to a child's overall health and immunity to many diseases. [5].

An early start to nursing, ideally within the first hour of birth, has been shown to have a considerable positive effect on lowering newborn mortality overall. For the first six months of life, exclusive breastfeeding (EBF) can lower the chance of death, foster healthy development, and shield newborns and babies from many disorders. [6]. According to estimates, 1.4 million deaths of children under five in underdeveloped countries may be avoided each year if children under two years old were to receive adequate breastfeeding care. [7]. EBF increases the chance of dying from pneumonia or diarrhea by more than two times. [8]. Three guidelines for IYCF practices are provided by the WHO for children between the ages of 6 and 23 months. i) Continue nursing or, if not, feed with calcium-rich foods; ii) feed solid or semi-solid food for a minimum number of times a day based on age and breastfeeding status; and iii) feed foods from a minimum number of food groups on a daily basis based on breastfeeding status. [9]. There are several indicators for optimal IYCF. It is recommended that infants begin nursing within one hour of birth, exclusively nurse during the first six months of life, and continue to consume breast milk until they are two years old and older. Age-appropriate complementary foods with the ideal feeding frequency and nutrient density should be provided starting at six months of age. In order to assess IYCF behaviors and evaluate treatments, the WHO developed a set of core and optional indicators in 2008. These indicators can be used in population-based surveys.[10].

Socio demographic factors associated with  included maternal age, education, income and health facility births [11]. Research indicates that maternal education is linked to meal frequency, dietary diversity, timely introduction of supplemental feeding, and minimum recommended diet [12]. Around 3•1 million children in this age range die each year due to malnutrition, which accounts for nearly half (45%) of all fatalities in children under five worldwide. [13]. The primary causes of Bangladesh's high infant death rate are respiratory infections, diarrheal illnesses, low birth weights, congenital defects, malnutrition, and a lack of access to healthcare services, among other community variables. [14].  In Bangladesh, as in many other low-income nations, malnutrition among children is a serious public health issue. Approximately 41% of children under five are stunted, 16% are wasted, and 36% are underweight. [15].

The government of Bangladesh has implemented numerous projects aimed at enhancing the nutritional status of children under two years old. In this situation, community-based IYCF counseling and assistance can be crucial in enhancing these procedures as well as guaranteeing that the poorest and most vulnerable groups have access to these services, making it a crucial tactic for programming with an equity focus. [18]. Comprehending how dietary diversity affects children's nutritional status can help guide nutrition policy and suggest initiatives that aim to enhance the quality of complementary meals. Therefore, the results of this study will be significant to Bangladeshi public health specialists and aid in the pursuit of the Sustainable Development Goal-2 (SDG-2) agenda, which seeks to eradicate all kinds of malnutrition by 2030. The purpose of the current study was to ascertain the eating practices of infants and young children aged 6 to 23 months, as well as the patterns and factors that influence them in Subarnochor, Noakhali, Bangladesh.

Methods

Study design

To gather information, a descriptive cross-sectional survey was carried out during June-July 2022 in the study area. In addition to providing some additional sociodemographic data about the study population, the survey was designed to gather information on IYCF practices and baseline indicators, such as early initiation of breastfeeding, exclusive breastfeeding (EBF), age-appropriate supplemental feeding, minimum dietary diversity (MDD), minimum meal frequency, minimum acceptable diet (MAD), feeding iron-rich food, and bottle feeding.

Study area and population

The study was conducted among mothers who had child less than 2 years of age, in subarnochor, Noakhali, Bangladesh. Noakhali, a south-eastern coastal district of Bangladesh in Chottogram division. The area was selected randomly from this district by multistage cluster sampling procedure. The study location was selected to offer context- and area-specific information, and the houses and study participants who consented to engage in the research were readily picked.

Sample size and Sampling technique

The study collected data conveniently from households according to their availability by considering the following assumptions: 90% confidence interval, 80% power, the proportion of EBF is 64% (one of the important indicators of IYCF) [20] with design effect of 1.5 and non-response of 10% which takes the sample size to 97 ≈ 100.

Data collection

Data were gathered using an organized pretested questionnaire that followed IYCF guidelines. The answers to these questions give the WHO's main indicators for IYCF, which describe exclusive breastfeeding and supplemental feeding, the information needed to compute them. In compliance with WHO guidelines, details regarding the child's diet for the preceding 24 hours were gathered, encompassing the kinds of foods consumed and how often they were consumed. Seven categories of food items were identified: cereals, legumes and nuts, dairy products, meat products, eggs, fruits and vegetables high in vitamin A, and other fruits and vegetables. [10].

Description of variables used in the study

The background information that was recorded included child age in months, height, weight, sex, family size, educational status of the parents, monthly income of the family, occupation of the father since almost all the mothers were unemployed housewives etc. Moroever, stunting, one of the anthropomentrc indicators of children’s nutritional status was considered. The study also included IYCF baseline indicators that were described below (Table 1):

Data analysis

All the data was entered in SPSS 23.0. The data was cleaned and all outliers were discarded after verification with actual questionnaires. Data editing, coding, recoding, missing values and other problems about data was identified and rechecked if necessary. Data was analyzed using SPSS Software package (SPSS 23.0), and ENA (Emergency Nutritional Assessment).

Categorical variables were presented as frequencies and percentages. Chi-square test of some variables with outcome variables was performed. Multivariable logistic regression analysis was used for the impact of each variable by odds ratio with 90% CI and p-value <0.1 being considered statistically significant. Initiation of breastfeeding, EBF, MDD, MAD and iron containing foods feeding were defined as binary variables in multivariate analysis. Effect of important IYCF indicators on stunting was also performed by bivariate logistic regression.

Ethical approval was obtained as per the rule of conduct. Approval was also taken from local administration and the participants were well aware about the pros and cons of the study; with proper consent the study was performed.

Results

Characteristics of study sample

The mean age of children was 14 months (SD ± 5.95 months); 55% of the mothers did not pass more than primary education. More than 50% of fathers were day laborer or small businessman, 46% families had three or more children and the gender proportion of the child was almost equal (56% and 44%). About 41% of family’s monthly income were between ten to twenty thousand-taka BDT (Table 2).

Infant and young child feeding practices

The IYCF practices in the research area are shown in Table 3. More over half of the women (63%) gave their kids colostrum; 57% breastfed their kids exclusively for the first six months of life, and 53% continued to nurse their kids for a year after that. Before six months and between six and eight months of age, 57% of moms started introducing solid, semi-solid, or soft foods to their infants. In the 24 hours prior to the study, only 74% of breastfed children (6–23 months) received the minimal meal frequency, 73% received the suggested MDD, and 57% received the MAD. In total, 40% of moms bottle-fed their children (39% of boys and 40% of girls). There were no appreciable differences in other IYCF practices between the genders.

Relationship of IYCF indicators with different variables

From table 4 it can be stated that mother’s education was a strong determinant of knowledge about exclusive breastfeeding duration (p<0.01); mother’s with secondary and higher secondary education had better knowledge than other women. Age came out as an important variable which describes with the increase of age the percentage of MDD increases. Moreover, only 34.2% stunted children achieved MDD and the percentage of children who consumed more iron containing foods increased with improved income; 36% children whose family income was >20000 BDT received iron rich foods always compared to only 5.9% children whose family income was below <10000 BDT.