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Appropriate feeding practices are crucial for survival, growth, and development in childhood. This paper analyzes Pakistan's Demographic and Health Survey 2012-2013 to fill the knowledge gap in risk factors of poor complementary feeding practices in Pakistani children. Multilevel models were applied to fit the multistage cluster sample of 2,827 children aged 6-23 months from 489 communities. Introduction of solid, semi-solid, or soft foods (intro) was achieved in 67% infants aged 6-8 months. Among children aged 6-23 months, the proportion of children meeting minimum meal frequency, dietary diversity (MDD), and acceptable diet criteria were 63%, 22% and 15%, respectively. Consumption of legumes and nuts, flesh foods, and vitamin A-rich fruits and vegetables was low in all children (6-19%), even among children who met the MDD criteria (15-55%). Younger child age, especially between 6 and 11 months and delayed maternal postnatal checkup were significant individual-level risk factors that consistently increased the odds of not meeting all four criteria examined. Fewer antenatal care visits predicted the odds of achieving intro and minimum meal frequency while younger maternal age and household poverty predicted the odds of achieving MDD and minimum acceptable diet. Community-level factors included geographic region and general access to maternal and child health care services. The overall poor quality of children's complementary diets in Pakistani calls for stronger policy and program action to promote the consumption of key nutrient-dense foods while prioritizing interventions for the most vulnerable children and populations. [ABSTRACT FROM AUTHOR]

Anemia remains one of the most intractable public health challenges in South Asia. This paper analyzes individual‐level and household‐level determinants of anemia among children and women in Nepal and Pakistan. Applying multivariate modified Poisson models to recent national survey data, we find that the prevalence of anemia was significantly higher among women from the poorest households in Pakistan (adjusted prevalence ratio [95% CI]: 1.10 [1.04–1.17]), women lacking sanitation facilities in Nepal (1.22 [1.12–1.33]), and among undernourished women (BMI < 18.5 kg/m2) in both countries (Nepal: 1.10 [1.00–1.21] and Pakistan: 1.07 [1.02–1.13]). Similarly, children in both countries were more likely to be anemic if stunted (Nepal: 1.19 [1.09–1.30] and Pakistan: 1.10 [1.07–1.14]) and having an anemic mother (Nepal: 1.31 [1.20–1.42] and Pakistan: 1.21 [1.17–1.26]). Policies and programs need to target vulnerable and hard‐to‐reach subpopulations who continue to bear a disproportionate burden of anemia. Covariates of poverty underpin rates of anemia among children and their mothers, but income growth alone will not suffice to resolve such deeply entrenched problems. Greater understanding of the relative role of various diet, health, sanitation, and educational factors by local context should guide investments to resolve anemia in tandem with stunting and maternal underweight. [ABSTRACT FROM AUTHOR]

The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non‐breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non‐EBF days may occur, EBF can be re‐initiated for extended periods. We compared breastfeeding metrics in the MAL‐ED study; infants' breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice‐weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non‐EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re‐initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studies. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6–59 months who were admitted to the programme with a mid‐upper arm circumference (MUAC) < 115 mm (January 1–December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6–23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight‐for‐height (WHZ) < −3 and/or height‐for‐age (HAZ) < −2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ −2 at admission. The odds of recovery on the basis of WHZ ≥ −2 were significantly higher among children with WHZ ≥ −3 and/or HAZ < −2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population‐level impact could be increased by giving priority to children 6–23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest. [ABSTRACT FROM AUTHOR]