Association of dietary diversity of 6–23 months aged children with prenatal and postnatal obstetric care: Evidence from a nationwide cross-sectional study

Abstract Background Dietary diversity is a key determinant of infant and young child eating patterns for a variety of food groups taken by children between the ages of 6–23 months. The study aimed to examine the association between prenatal and postnatal obstetric care factors of mother and child’s dietary diversity, and specific food practices in Bangladesh. Methods This study analyzed the data of 2497 children between the age of 6–23 extracted from the latest countrywide Bangladesh Demographic Health Survey 2017–2018 and explored relationships between prenatal and postnatal obstetric care received by mother and dietary diversity score (DDS), minimum dietary diversity (MDD), and introduction of solid, semi-solid, and soft foods (ISSSF) of their children. Results Findings revealed that ≥ 4 antenatal care (ANC) visits care visits increased the DDS (adjusted $$\beta$$ β : 0.32, 95% CI [0.21, 0.43]), increased the likelihood of MDD (AOR 1.54, 95% CI [1.23, 1.93]), and ISSSF (AOR 1.24, 95% CI [1.08, 1.48]), consuming eggs (AOR 1.47, 95% CI [1.23, 1.76]), and vitamin A vegetables and fruits (AOR 1.38, 95% CI [1.15, 1.66]). Moreover, DDS (adjusted β: 0.05, 95% CI [0.00, 0.11]) and MDD (AOR 1.66, 95% CI [1.31, 2.11]) are linked to childbirth in a medical facility. The C-section delivery influences the DDS (adjusted $$\beta$$ β : 0.05, 95% CI [0.00, 0.10]), MDD (AOR 1.39, 95% CI [1.10, 1.75]), and ISSSF (AOR 1.22, 95% CI [1.02, 1.48]). Besides, postnatal visits within 48 h of delivery linked to MDD (AOR 0.66, 95% CI [0.49, 0.89]) and ISSSF (AOR 0.76, 95% CI [0.59, 0.97]), and physicians or professionals providing postnatal checkups were significantly associated with DDS (adjusted $$\beta$$ β : 0.09, 95% CI [0.02, 0.16]), MDD (AOR 1.69, 95% CI [1.26, 2.26]), and ISSSF (AOR 1.30, 95% CI [1.04, 1.62]). Conclusion Knowledge of child nutritional feeding should emphasize during prenatal and postnatal obstetric care of mother, particularly during antenatal and postnatal visits, C-section delivery, and birth in a healthcare facility to eradicate malnutrition and establish healthy child feeding practices.

【摘要 背景】饮食多样性是6~23月龄婴幼儿摄入各类食物的饮食模式的关键决定因素。本研究旨在探讨孟加拉国母亲的产前、产后产科护理相关因素与儿童饮食多样性，以及特定喂养行为之间的关联。
【研究方法】本研究从2017-2018年孟加拉国最新全国人口与健康调查中提取了2497名6~23月龄儿童的数据，分析了母亲所接受的产前、产后产科护理与儿童饮食多样性评分（Dietary Diversity Score, DDS）、最低饮食多样性（Minimum Dietary Diversity, MDD）以及固体、半固体与软食引入（Introduction of Solid, Semi-solid, and Soft Foods, ISSSF）之间的关联。
【研究结果】结果显示，产前保健（Antenatal Care, ANC）次数≥4次可提升儿童饮食多样性评分（校正β=0.32，95%置信区间[CI]：0.21~0.43），提高儿童达到最低饮食多样性（调整比值比（Adjusted Odds Ratio, AOR）=1.54，95%CI：1.23~1.93）、引入固体半固体软食（AOR=1.24，95%CI：1.08~1.48）、摄入蛋类（AOR=1.47，95%CI：1.23~1.76）以及富含维生素A的蔬菜与水果（AOR=1.38，95%CI：1.15~1.66）的可能性。此外，在医疗机构分娩与儿童饮食多样性评分（校正β=0.05，95%CI：0.00~0.11）以及最低饮食多样性达标率（AOR=1.66，95%CI：1.31~2.11）显著相关。剖宫产分娩同样对儿童饮食多样性评分（校正β=0.05，95%CI：0.00~0.10）、最低饮食多样性达标率（AOR=1.39，95%CI：1.10~1.75）以及固体半固体软食引入率（AOR=1.22，95%CI：1.02~1.48）存在影响。此外，分娩后48小时内开展产后访视与儿童最低饮食多样性达标率（AOR=0.66，95%CI：0.49~0.89）以及固体半固体软食引入率（AOR=0.76，95%CI：0.59~0.97）相关；由医师或专业人员提供产后检查则与儿童饮食多样性评分（校正β=0.09，95%CI：0.02~0.16）、最低饮食多样性达标率（AOR=1.69，95%CI：1.26~2.26）以及固体半固体软食引入率（AOR=1.30，95%CI：1.04~1.62）显著相关。
【结论】在母亲的产前、产后产科护理全过程中，尤其是产前访视、产后访视、剖宫产分娩以及医疗机构分娩环节，应强化儿童营养喂养相关知识的宣教，以根除营养不良，建立健康的儿童喂养行为。