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Fish and Meat Are Often Withheld from the Diets of Infants 6 to 12 Months in Fish-farming Households in Rural Bangladesh

Andrew L. Thorne-Lyman, MHS, ScD
Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Natalie Valpiani, MS, MPH, PhD
WorldFish Headquarters, Penang, Malaysia

Rumana Akter, MsC
WorldFish Bangladesh, Banani Dhaka, Bangladesh

Md Abdul Baten, MBA
WorldFish Bangladesh, Banani Dhaka, Bangladesh

Sven Genschick, MS, PhD
WorldFish Headquarters, Penang, Malaysia

Manjurul Karim, PhD
WorldFish Bangladesh, Banani Dhaka, Bangladesh

Shakuntala H. Thilsted, PhD
WorldFish Cambodia, Phnom Penh, Cambodia

Abstract/ Executive Summary:

Background: Fish is a widely available animal-source food in Bangladesh and a rich source of nutrients, yet little is known about practices related to incorporating fish into the diets of infants and young children. Objective: Use dietary diversity data to explore consumption patterns of fish and high-quality food items within the household and examine factors associated with delayed introduction of fish to infants and young children. Methods: Cross-sectional survey of 496 households with children <36 months participating in the Aquaculture for Income and Nutrition project in Bangladesh. Data collected included household characteristics, women’s dietary diversity score, and minimum dietary diversity score along with data on Infant and Young Child Feeding practices. Results: Most children (63.4%) met the threshold for minimum dietary diversity. Despite having received extensive nutrition education related to including fish in complementary foods, only half of the caretakers introduced fish at 6 months and the mean age of introduction of small fish was 8.7 months. Meat and fish were not common in infant diets but increased with child age. Concerns about bones were a major barrier to incorporating fish into infant diets. Conclusion: Given its nutrient profile and widespread availability in certain contexts, fish could be an underutilized opportunity to improve nutrition and health outcomes of infants and young children. Further research, including utilizing food processing technologies, is needed to develop appropriate responses to overcome these barriers

Keywords: Aquaculture, Fish, Infant and young child feeding, Bangladesh, Micronutrients, Dietary quality

Location: Bangladesh

Start Date:

End Date:

Program Area: Quality and Nutrition

Commodity: Fish

Objectives:

The main objectives of the study were to (1) understand differences between maternal and child consumption of quality food items, especially fish, (2) explore the prevalence of withholding fish from the diets of infants and young children, and (3) examine factors associated with the delayed introduction of fish in the diets of infants and young children and whether this practice differs for small fish versus large fish species.

Methodology:

Study Population and Sample Selection The Aquaculture for Income and Nutrition (AIN) project is a 5-year (2011-2016) US Agency for International Development (USAID) Feed the Future investment in southern Bangladesh, focusing on strengthening aquaculture production systems. Over 2 years of project participation, households owning small ponds receive training in aquaculture production and behavior change communication components aimed at encouraging greater dietary diversification, particularly among pregnant and lactating women and infants and young children. The nutrition training focused on essential nutrition and hygiene actions, focused on safe preparation of age-appropriate complementary foods, participation in nutritional care and health services, and handwashing and was attended by both women and men. In addition, cooking demonstrations were given incorporating training on how to safely prepare small fish for consumption by young children by mashing the fish and bones. Of the 8 total AIN training sessions conducted over the course of a year, 7 incorporated 30 minutes of nutrition education each, with a 2- hour final session related to nutrition. The study population consisted of households in 30 districts across the divisions of Barisal, Khulna, and parts of Dhaka. This cross-sectional survey focused specifically on households engaged in homestead pond aquaculture and enrolled in the project in 2014. Eligibility criteria for participation in the AIN project included (1) residence in a targeted area, (2) land ownership <250 decimals (1 decimal ¼ 40 m² or income BDT <165 000 (US$2134 in 2014)/ month, (3) pond size between 5 and 50 decimals, (4), a reproductive-aged woman with a child <36 months of age in the household, and (5) willingness to adopt fish culture/management practices and interest in attending project training sessions. In communities that had more willing and eligible households than project openings, female farmers and single pond owners were given priority for selection into the project. We aimed to enroll 500 households in the study; this sample size was based on resources available for the survey. We used simple random sampling to select 500 households from a comprehensive list of 1854 project households who either had a child younger than 36 months or a pregnant woman in the household when they were enrolled in the project in 2014. Training and Data Collection Bangla-speaking enumerators were recruited, each of whom had previous experience conducting similar surveys for national and international organizations. The data collection team then received a 2-weeks’ training by aquaculture and nutrition experts, including pretesting of the questionnaire in the field. The training included interview techniques, a review of the indicators used in the survey, and field practice. Data collection took place from November to December 2014. Consistent with the Helsinki Declaration as revised in 1983, informed consent was obtained orally from all study participants. The 18 enumerators were organized in teams of 2, consisting of 1 female and 1 male who jointly administered the 2-part questionnaire. The female enumerator collected information on the diet of mothers and their young children. The male enumerator collected data on aquaculture and vegetable production from the person in charge of homestead aquaculture and pond-dyke vegetable production, which in most cases was the adult male of the household. Three field supervisors ensured data quality control by facilitating the enumerators’ work and by conducting spot checks in the field. In addition to the spot checks, a female and male data quality control officer each reinterviewed 30 households, using an abbreviated version of the questionnaire, within 24 hours of primary data collection to compare and to validate the quality of the data set.

Source of Information: Food and Nutrition Bulletin 2017, Vol. 38(3) 354-368

Article Link (Online Journal): https://doi.org/10.1177/0379572117709417

Funding Source:

Budget:

Total Budget (Tk.) :

Achievement/Findings:

International guidelines stress that where possible, local foods should be used to meet the nutritional needs of infants and young children.2 Introducing a diverse range of healthy foods to infants and young children can also help to shape future preferences and behaviors, thereby potentially reducing the risk of chronic disease later in life.38 Even in contexts where other solutions to micronutrient deficiencies such as fortified foods or micronutrient powders are introduced, such approaches should be used to augment and not replace dietary diversification.2 Fish, particularly small indigenous species, are an important and accessible source of multiple nutrients in Bangladesh and other aquatic settings. Our study, set in the context of an aquaculture project, demonstrated that in spite of the inclusion of a nutrition education component emphasizing the inclusion of fish in the diets of infants and young children, a significant proportion of women delayed the introduction of fish into the diets of young children, even when they themselves consumed it. More research is needed to explore reasons behind the withholding of fish (and meat), to understand how this may relate to women and caretaker’s time, roles and other household responsibilities, to explore differences by child gender in this practice, and to explore alternative strategies to mitigate concerns about bones such as teaching techniques to remove bones from fresh fish, to powder dried small fish, or to increase access to fish-based complementary food products.

Knowledge Management: Journal