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Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

28 

 

 

Levels and Determinants of Complementary Feeding Pattern Exclusive of 

Minimum Meal Frequency and Dietary Diversity among Children of 6 to 

23 Months in Bangladesh  

 

Naznin Pervin1, Darryl Macer2, Shamima P. Lasker3 

 
1. BDS, MSc, MHE, MPH, Consultant Dental Surgeon, Salauddin Specialized Hospital Ltd , Email: 
nazneenmowshumy@gmail.com 
2.MPH, Ph.D., Hon.D., AUSN President; Provost; AUSN Professor of Bioethics and Biomedicine; Director, 
Eubios Ethics Institute (Chair),Email: provost@ausn.info 
3.PhD (USA), MPH (USA), EMMB (Europe), MPhil (BD), MSc (BD); Professor & Head of Anatomy, 
Shahbuddin Medical College, Dhaka, Bangladesh. Visiting Professor of Clinical Anatomy & Bioethics, 
American University of Sovereign Nation, USA. Founding Chairman & Sectary General, Bangladesh Bioethics 
Society, Treasurer, World Association of Medical Editors (WAME), Chairperson, Ethics & Publication, Asian 
Pacific Association of Medical Editors (APAME), Email: splasker04@yahoo.com  Orcid ID: 
https://orcid.org/0000-0002-3484-9526  

Abstract: Objective: To estimate the level of complementary feeding pattern (CFP) among children 

aged between 6 to 23 months and to identify the determinants in individual, household and community 

level in Bangladesh. Methods: From secondary data of Bangladesh Demographic Health Survey 

(BDHS) 2011 was used in this study. A total of 2,373 children aged between 6 to 23 months were 

selected. To estimate the level of CFP dimension index and the “score of the index” was used as 

dependent variables. Statistical analyses and tests were guided by the nature of the variables. 

Multivariable logistic regression analyses were performed to identify the significant determinants of 

CFP. Results: The overall level of CFP among children aged between 6 to 23 months was low. More 

than 95% of the children experienced inadequate (92.7%) CFP level. The mean levels of CFP as well 

as percentages of no or inadequate (94.1%) CFP were significantly lower among children of the 

youngest age group (06 months), uneducated parents, unemployed/laborer fathers, socio-economically 

poor families, food insecure families and rural areas. However, only few variables remained significant 

for adequate CFP in the multivariable logistic regression analysis. Adequate CFP was significantly 

lower among the children aged between 6 to 23 months (OR: 0.22, 95% CI: 0.10-0.47), children of 

illiterate fathers (OR: 0.32, 95% CI: 0.11-0.95) and socio-economically middle-class families (OR: 

0.28, 95% CI: 0.09-0.86) as compared to their reference categories. Conclusion: Inappropriate and 

inadequate CFP may cause serious health hazards among children of 6 to 23 months in Bangladesh. It 

is ethical to take effective interventions and strategies by the government and other concerned 

stakeholders to improve the overall situation of CFP in Bangladesh.  

 

Key words: CFP, children, individual, household, community, Bangladesh, Complementary Feeding, 

Minimum Meal Frequency, Dietary Diversity. 

 

Introduction: Malnutrition is the largest 

risk factor in the world for disability and  

premature mortality among young children, 

especially in developing countries. 

Although the condition is entirely 



Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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preventable. Malnutrition is a significant 

underlying factor in more than half of the 

deaths of young children in these 

countries1. Recent analyses have found a 

decrease in child deaths under 5 years of 

age to 8.795 million in 2008 worldwide 2. 

and 7.7 million in 2010 3 , yet malnutrition 

remains one of the key factors associated 

with global loss of life in young 

children2,4,5. The objective of millennium 

development goals (MDGs) of United 

Nations (UN) focused on reducing poverty, 

and extreme hunger, and improving 

education by 2015 6. One of the objectives 

of MDG was to decrease the prevalence of 

underweight children under 5 years of age 

(under-5 children) as the primary measure 

of malnutrition by 2015 6. 

In Ethiopia, 47%, 11% and 38% of children 

under five years of age were stunted, 

wasted and underweight, respectively7. An 

Ethiopian child is 30 times more likely to 

die by his or her fifth birthday than a child 

in Western Europe and the most common 

cause of child death is the interacting 

combination of malnutrition and infection 8. 

 

Proper feeding practices during infancy and 

early childhood are fundamental for normal 

growth, development, and survival of 

infants and children, particularly in 

developing countries 9,10,11. South Asian 

countries including Bangladesh reveal the 

highest burden of childhood undernutrition 

due to unimproved feeding of children that 

causes faltered growth and development, 

and illness, such as, respiratory infections, 

diarrheal diseases etc 9,12. According to the 

various studies, 6-23 months of age of a 

child is a “critical window” for the 

transition of body and cognitive 

development 9,13. After 6 months of age, 

children need complementary food because 

breast milk or infant formula alone is no 

longer sufficient to maintain the child’s 

growth 9,13. At this stage, children should be 

fed small quantities of nutritional solid and 

semisolid foods in addition to breast-

feeding 13. The World Health Organization 

(WHO) and the United Nations 

International Children’s Emergency Fund 

(UNICEF) have articulated a global 

strategy and formulated guidelines for 

complementary feeding of the breastfed 

child 14.  Although appropriate 

complementary feeding pattern (CFP) 

among children aged between 6 to 23 

months brings numerous health benefits 9, 

inappropriate and inadequate introduction 

of CFP may increase the risk of 

malnutrition among under-five children 
7,15,16. The levels of CFP are affected by 

numerous individual, household and 

community level factors 9,16. The 

undernourished children are more likely to 

develop severe health hazards that impede 

body’s metabolism and retard utilization of 

immunity resulting from deficiencies in 

immune competence 17,18.   

 

Although Bangladesh has made 

magnificent progress in health and human 

development since its independence in 

1971 19,10, this country shows limited 

success in beating the odds of child 

malnutrition. For instance, the prevalence 



Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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of under-five child malnutrition in 

Bangladesh is nearly 40%, which causes 

nearly 60% of under-five deaths 21. 

Inappropriate feeding practice could be one 

of the profound causes of high under-five 

mortality in this country 22.  

 

Considering the limited number of studies 

in Bangladesh, this study aimed to estimate 

the levels of CFP among children of 6 to 23 

months using composite dimension index 

and then to identify the determinants of 

CFP focusing on individual, household and 

community level factors. To our 

knowledge, none of the previous studies 

used composite dimension index to 

measure the levels of CFP in Bangladesh. 

Although dimension index is originally 

developed and used to calculate Human 

Development Index by the United Nations 

Development Programme (UNDP), it is 

also applied to address other issues 23,24. 

 

Ethical Implication: In this study 

secondary data was used. Hence IRB 

approval was not necessary. However, 

verbal consent was taken from BDHS. 

Since studies based on Dimension index to 

interpret CFP are still scarce, further reports 

to provide universally accepted cut off 

points to define different groups of CFP 

would be immensely useful for the 

purposes of comparison, monitoring, 

evaluation and advocacy.  

 

The primary causes of malnutrition include 

a lack of quality food, poor infant and child 

feeding and care practices such as 

suboptimal breastfeeding, deficiency of 

micronutrients such as vitamin A or zinc, 

and recurrent attack of infections, often 

intensified by intestinal parasites 25 In this 

perspective, this research is very important 

in this area to address the child feeding 

practice.  

  

Objectives: General objectives: There is 

limited research on CFP and minimum 

meal frequency and dietary diversity 

among children of 6 to 23 months in 

Bangladesh. Therefor this study has been 

undertaken to estimate the levels of CFP 

among children of 6 to 23 months using 

composite dimension index and then to 

identify the determinants of CFP focusing 

on individual, household and community 

level factors. 

 

Specific Objectives:  

1. To find out the levels of CFP among 

children aged 6 to 23 months.  

2. To find out the prevalence of practice of 

CFP based on multilevel factors. 

3. To identify the determinants of CFP 

 

Methodology: This retrospective study 

was performed by analysis of surveys 

conducted by Bangladesh Demographic 

and Health Survey (BDHS) in 2011 which 

was a nationally representative cross-

sectional survey, during August to 

November, 2015 for the master thesis of 

American University of Sovereign Nations 

(AUSN). 



Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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Inclusion and exclusion criteria: A total 

of 8,761 under-five children (unweighted) 

born after January 2006 or later, were 

considered for anthropometric 

measurements, of which data 

(anthropometric and age) were completed 

for 7,647 children (around 88%). Among 

them 2,373 children aged between 6 to 23 

months were considered as final sample 

(figure 1). (All the under-five children 

outside the range of 6-23 months were 

excluded from the analysis. From the total 

of 2,405 children aged 6-23 months, 32 

children were excluded due to missing 

information. Therefore, the final sample for 

analysis was 2,373 children aged 6-23 

months).  

Measuring levels of CFP and outcomes: 

To measure the level of CFP among 

children, 20 frequently asked questions 

(indicators) had been included for eligible 

mothers of households (Figure 2).They 

were: complementary food items namely, 

1. plain water. 2. Noodles, bread and others 

made from grains. 3. Other solid, semisolid. 

4. Potato, cassava and other tubers. 5. Fish 

or shellfish. 6. Any dark green leafy 

vegetable. 7. Eggs. 8. Tinned, powdered or 

fresh milk. 9. Any other fruits. 10. Other 

liquid other than juice. 11. Juice. 12. Meat. 

13. Pumpkin, carrot, squash. 14. Mangoes, 

papayas, other vitamin A fruits. 15. Baby 

formula. 16. Foods made from beans, peas, 

lentils, nuts. 17. Fortified baby food. 18. 

Yogurt 19. Liver, heart, other organs. 20. 

Cheese, dessert, other milk products. For 

each question, responses were coded binary 

as 1= yes (practice) and 0 = no (not 

practice). Thereafter, the formula of 

“dimension index” (given below) was used 

in accordance with the construction method 

of the Human Development Index (HDI) to 

estimate the level of CFP 26. Firstly, 

Cronbach’s alpha coefficient was used to 

evaluate the internal reliability of the 20 

indicators. According to our analysis, the 

Cronbach’s alpha estimate was 0.701, 

suggesting a high internal consistency. The 

index was then constructed using the sums 

of weighted binary input variables where 

maximum and minimum values were also 

chosen for underlying dimension. 

Performance of the dimension index was 

expressed into a unit-free index between 0 

and 1 26 .The index is defined as:  

 
Dimension Index

=
Actual value − Minimum value

Maximum value − Minimum value
 

 

The actual value here indicates the sum 

score of 20 binary indicators for each 

respondent and the maximum and 

minimum values were 20 and 0, 

respectively. The individual score of CFP 

(based on dimension index) was converted 

into percentage by multiplying 100. These 

scores were then divided into two 

categories. 1. Individuals with dimension 

score of exactly 0 % belonged to the “no 

CFP” group. 2. Individuals with other 

scores ranging from 1-100 % belonged to 

the “CFP” group (20). The CFP scores were

 



Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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Figure 1: Sample size selection 

 

Figure 2: Percentage of complementary foods received by children (BDHS 2011) 

A total of 8,550 children under 5 years of age 
were eligible for anthropometric measurements 

8,435 Children have complete and credible 
anthropometric data 

Height and weight data are missing for 115 

7,647 Children have complete and credible 
anthropometric and age data 

Age data are missing for 790 children 

5,242 children age less than 6 months and 
greater than 23 months were excluded 

2,405 Children have complete and credible 
anthropometric, nutrition and age data 

Mothers of 32 children who respond “Do not 
know” for CFP were excluded  

2,373 children deemed eligible for the present 
study (Final data) 

32 



Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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again divided into three categories: no CFP 

(0 %), inadequate CFP (1-49%) and 

adequate CFP ( 50.0%). Both variables 

with two and three categories were used as 

dependent variables in multivariable 

analyses. 

Covariates: Covariates were classified into 

three level characteristics: individual, 

household, and community characteristics. 

Individual level characteristics were: age of 

child (6-11 months, 12-17 months, 18-23 

months); sex of child (male, female); 

mother’s education (illiterate, literate); 

father’s education (illiterate, literate); 

father’s employment status (currently 

unemployed composed of unemployed 

persons and students, laborers composed of 

farmer, agricultural worker, fisherman and 

rickshaw etc.; service holders composed of 

doctor, lawyer, accountant, teacher and so 

on; businessman). Household socio-

economic status based on wealth index 

(poor, middle, rich), mass media exposure 

through television, radio and 

newspaper/magazine (yes: all medias 

exposed to at least once a week, no); food 

insecurity (yes, no) were considered as the 

household level characteristics. The wealth 

index was constructed using household 

asset data via principal components 

analysis 27.  

Household socio-economic status was 

considered as the household-level 

characteristics. Household socioeconomic 

status, namely the wealth index was 

constructed from data on household assets, 

including ownership of durable goods 

factors with CFP. Statistical significance 

(analyses were carried out using SPSS software 

(version 20.0). such as televisions and 

bicycles) and dwelling characteristics (such 

as source of drinking water, sanitation 

facilities, and construction materials). 

Principal components analyses were used 

to assign individual household wealth 

scores. These weighted values were then 

summed and rescaled to range from 0-1, 

and each household was assigned into 

quintiles: the first quintile: poorest, the 

second quintile: poorer, the third quintile: 

middle class, the fourth quintile: richer and 

the fifth quintile: richest 27. Five household 

food security indicators were selected using 

the Household Food Insecurity Access 

Scale. Community level characteristics 

were represented by the place of residence 

(urban, rural) and region of residence 

(south, south-east, central, mid-west, north-

west, and east). 

 

Statistical analysis: The continuous score 

of CFP based on dimension index were 

tested using ANOVA-test and t-test. These 

tests tested the differences of CFP among 

various categories of each independent 

variable. Contingency analysis was used to 

test the bivariable associations between the 

CFP (with three categories) and selected 

factors by applying the Chi-square (  2) 

test. Multivariable binary/multinomial 

logistic regressions (binary for CFP scores 

with two categories and multinomial for 

CFP scores with three categories) were 

3333 



Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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used to examine the associations of selected 

was accepted at P < 0.05. Statistical  

 

Study limitations: This study is not free 

from limitations. Due to unavailability of 

recent data, 27. Data was used in this study 

that does not present the current nutritional 

status. The cross-sectional nature of the 

study limits us to assess the cause and effect 

relationships between selected factors and 

CFP. Most of the food items were given to 

the children in last 24-hours preceding the 

survey time, however, the children could 

occasionally receive some other foods but 

simply did not the previous day. All food 

items were treated equally may limit this 

study. Another limitation could be 

information bias, which may result from 

collecting information of self-reporting 

age, education, occupation, household 

assets as well as nutritional indicators. 

 

Result: The mean level of CFP was 24.2, 

which was significantly lower among the 

children aged 6-11 months (19.1%), 

illiterate mother (18.8%), illiterate father 

(19.8%) and also among children of 

currently unemployed families (22.6%) 

(Table 4.1). Children belonging to the 

poorest socio-economic group (19.6%), no 

exposure to television (20.7%) and 

newspapers (22.9%), food insecurity 

(22.2%) and rural area (20.70%) also 

revealed significantly lower scores of CFP. 

Moreover, the mean level of CFP varied 

significantly among various geographical 

regions with the lowest level in 

southeastern region.  

The overall level of CFP experienced by 

children aged between 6 to 23 months in 

Bangladesh could be described as a 

catastrophe. Poor level of CFP was 

measured significantly using multilevel 

factors, such as, age, parental education, 

father’s employment status, socio-

economic status, mass media exposure, 

food insecurity, pace of residence and 

region of residence.  

 

Interclass variations of the percentages, 

based on multilevel factors (e. g. individual, 

household and community levels), of the 

children among the various level of CFP 

(e.g. no CFP, inadequate CFP and adequate 

CFP) were observed using Chi-square test. 

According to the categories of dimension 

index, more than 90% children received 

inadequate complementary food. Children 

age, mother’s education, father’s education, 

father’s employment status, socio-

economic status, mass media exposures 

(television and newspaper/magazine), food 

insecurity and place of residence were 

significantly associated with CFP 

categories (Table 4.2). For instance, the 

percentage of adequate CFP was 

significantly lower among younger group 

of children (2.5%), among children of 

illiterate mother (1.8%), illiterate father 

(1.0%). Similarly, the percentage of 

adequate CFP was significantly lower 

among the children of those families, who 

belonged to the groups of socio- 

economically poor (1.6%), no mass media 

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Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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Table 4.1 Mean level of complementary feeding practice 
Variables 

Mean ( SD) (%) 
Standard Error (SE) (%) P values 

Children age (months)    

6-11 
19.1 ( 11.7) 0.40  

12-17 26.2 ( 11.8) 0.42 <0.001a 

18-23 28.0 ( 12.2) 0.45  

Sex of child    

Male 23.9 ( 12.4) 0.36 0.332b 

Female 
24.5 ( 12.5) 0.36  

Mother’s education    

Illiterate 18.8 ( 9.97) 0.51 <0.001b 

Literate 25.2 ( 12.7) 0.28  

Father’s education    

Illiterate 
19.8( 10.7) 0.43 <0.001b 

Literate 25.7 ( 12.7) 0.30  

Father’s employment status    

Currently unemployed 22.6 ( 13.9) 1.91  

Labours  23.3 ( 11.8) 0.29 <0.001a 

Service holders 
26.1 ( 13.2) 0.59  

Businessmen 28.8 ( 14.5) 1.20  

Socioeconomic status    

Poor 19.6 ( 10.6) 0.47 <0.001a 

Middle 21.4 ( 11.1) 0.52  

Rich 
26.7 ( 12.8) 0.34  

Watch television weekly    

No 20.7 ( 11.1) 0.36 <0.001b 

Yes 
26.5 ( 12.8) 0.34  

Listen to radio weekly    

No 24.1 ( 12.5) 0.27 0.179 

Yes 25.3 ( 12.8) 0.89  

Read newspapers/magazine weekly    

No 
22.9 ( 11.8) 0.27 <0.001b 

Yes 30.4 ( 13.7) 0.68  

Food insecurity    

No 25.3 ( 12.9) 0.33 <0.001b 

Yes 22.2 ( 11.3) 0.40  

Place of residence    

Urban 27.4 ( 13.4) 0.49 <0.001b 

Rural 22.8 ( 11.8) 0.29  

Region of residence    

Southern 23.7 ( 12.5) 0.76  

Southeastern 22.3 ( 12.9) 0.58  

Central 23.6 ( 12.7) 0.66  

Western 28.8 ( 11.4) 0.69 <0.001a 

Mid-western 26.2 ( 11.8) 0.67  

Northwestern 25.9 ( 11.2) 0.65  

Eastern 21.1 ( 12.6) 0.67  

Total 24.2 ( 12.5) 0.26  

SD, Standard deviation; SE, Standard error;  

a = ANOVA test; b = T-test 

35 



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exposure (2.0% for television and 3.0% 

newspaper/magazine), food insecurity 

(2.6%) and rural area (3.0%). In contrast, 

the percentage of inadequate CFP was 

significantly higher among younger the 

children aged 12-17 months (94.1%), 

among children of illiterate mother 

(95.3%), illiterate father (95.9%), the 

children of those families, who belonged to 

the groups of socio-economically poor 

(95.4%), no mass media exposure (94.6% 

for television and 94.0% 

newspaper/magazine), food insecurity 

(94.7%) and rural area (93.7%). Only 4.4% 

children were found to receive adequate 

CFP. All multilevel factors other than sex 

of child, listening to radio and region of 

residence were significantly associated 

with CFP.  

 

Multivariable association of CFP with 

multilevel independent variables: 

Multivariable logistic regression 

(binary/multinomial) analysis have been 

performed to identify the determinants of 

CFP or to observe the effects of several 

socio-demographic factors based on 

individual, household and community level 

factors. The results of binary logistic 

regression were presented first under the 

dichotomous dependent variable “any 

CFP”.  

According to these results (Table 4.3.), 

children aged between 6 to 23 of age were 

less likely to receive any CFP (OR: 0.55, 

95% CI: 0.32-0.96) as compared to the 

group of 18-23 months. In contrast, 

children of 12-17 months of age were more 

likely to receive any CFP (OR: 2.63, 95% 

CI: 1.14-6.07). Other variables were not 

significantly associated with the dependent 

variable “any feeding practice”.   

According to the results of multinomial 

logistic regression analysis (presented 

under the categories of inadequate and 

adequate take ‘no CFP’ as a reference in 

Table 4.3), children of illiterate fathers had 

significantly less likelihood of having 

adequate CFP (OR: 0.32, 95% CI: 0.11-

0.95). Children from the socioeconomically 

middle class families were less likely to 

receive adequate CFP (OR: 0.28, 95% CI: 

0.09-0.86) as compared to rich children. 

Children of families with no exposure to 

newspaper/magazine also revealed 

significantly less likelihood of receiving 

adequate CFP (OR: 0.38, 95% CI: 0.16-

0.92) than reference category. Place of 

residence had somewhat significant effect 

(P=0.09) on adequate CFP.  

Most of the socio-demographic variables 

were not significantly associated with CFP. 

Some factors, such as, children age, father’s 

education, socioeconomic status and 

frequency of reading newspaper/magazine 

had significant effects on adequate CFP.    

 

Table 4.4 highlights the association 

between child underweight and CFP. CFP 

was significantly (p=0.005) associated with 

underweight. More than 30% children 

received inadequate complementary foods 

were underweight. Other factors, such as, 

children age, mother’s education, father’s 

education, father’s occupational status, 

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Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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socio-economic status, watch television 

weekly, read newspapers/magazine 

weekly, food insecurity, place of residence 

and region of residence  were significantly 

associated with child underweight.  

 

Binary logistic regression analysis showed 

that CFP had significant effect on child 

underweight. Children who were fed 

inadequate food had more chance to be 

underweight than those who did not receive 

any complementary food. Other factors, 

such as, children age, socio-economic 

status, watch television weekly, read 

newspapers/magazine weekly, food 

insecurity, place of residence and region of 

residence had significant impact on child 

underweight.  

 

Discussion: The study reveals a low level 

of CFP (composed of no CFP or low CFP) 

among children aged between 6 to 23 

months in Bangladesh. The higher 

prevalence of under-nutritious 

complementary foods during the early 

mentioned “critical window” period of 

growth for children. Our findings are 

consistent with the findings of a study in 

Bangladesh 28. and other South Asian 

countries such as India, Pakistan, Sri Lanka 

and Nepal 9,29,30. Lack of knowledge and 

awareness regarding appropriate CFP may 

influence the poor nutritional supplements 

among children 31. According to my 

knowledge, no previous studies have 

addressed the level of CFP through 

dimension index based on 20 

complementary food items.  

We found significant interclass variations 

of CFP for different individual, household 

and community level variables. For 

instance, receiving complementary foods 

were significantly lower among children of 

the younger age group (6-11 months) than 

among those in the older age group (18-23 

months). Several studies reported that 

percentages of infants receiving 

complementary foods increases with age 

but did not show any significant variations 
32,33,34 . CFP was also found significantly 

lower among children of illiterate parents, 

children of fathers who were labourers, 

socioeconomically poor families, children 

of families never exposed to mass media, 

food insecure families and rural settlement. 

These findings were consistent with 

another study conducted in Nepal 34.  

 

The United Nations Children’s Fund 

(UNICEF) reported that in Bangladesh over 

33 million children under 18 years of old, 

which accounts for around 56% of the child 

population, are currently living below the 

international poverty line and around 57% 

are deprived of adequate nutrition 27. 

Bangladesh is one of the South Asian 

countries where female children experience 

higher mortality than males 35. In this 

country, more attention is paid to male 

children in intra-family food distribution 

and healthcare. Such kinds of discrimination 

against female children can aggravate the 

situation of under-nutrition and other health  

37 



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Table 4.2 Associations between multilevel factors and complementary feeding pattern 

Variables 
Complementary feeding pattern 

P values 
No Inadequate CFP Adequate CFP 

Children age (months)     

6-11 41 (4.8%) 791 (92.7%) 21 (2.5%) <0.001 

12-17 8 (1.0%) 753 (94.1%) 39 (4.9%)  

18-23 19 (2.6%) 656 (91.1%) 45 (6.2%)  

Sex of child     

Male 36 (3.0%) 1109 (92.5%) 54 (4.5%) 0.903 

Female 32 (2.7%) 1091 (92.9%) 51 (4.3%)  

Mother’s education     

Illiterate 11 (2.9%) 362 (95.3%) 7 (1.8%) 0.028 

Literate 57 (2.9%) 1838 (92.2%) 98 (4.9%)  

Father’s education     

Illiterate 19 (3.1%) 580 (95.9%) 6 (1.0%) <0.001 

Literate 49 (2.8%) 1620 (91.6%) 99 (5.6%)  

Father’s employment status     

Currently unemployed 3 (5.7%) 48 (90.6%) 2 (3.8%)  

Labours  45 (2.7%) 1568 (94.2%) 52 (3.1%) <0.001 

Service holders 17 (3.3%) 457 (89.8%) 35 (6.9%)  

Businessmen 3 (2.1%) 127 (87.0%) 16 (11.0%)  

Socioeconomic status     

Poor 15 (3.0%) 474 (95.4%) 8 (1.6%) <0.001 

Middle 17 (3.7%) 433 (95.0%) 6 (1.3%)  

Rich 36 (2.5%) 1293 (91.1%) 91 (6.4%)  

Watch Television weekly     

No 31 (3.3%) 880 (94.6%) 19 (2.0%) <0.001 

Yes 37 (2.6%) 1320 (91.5%) 86 (6.0%)  

Listen radio weekly     

No 61 (2.8%) 2013 (92.9%) 94 (4.3%) 0.691 

Yes 7 (3.4%) 187 (91.2%) 11 (5.4%)  

Read newspapers/magazine weekly 
  

  

No 59 (3.0%) 1850 (94.0%) 60 (3.0%) <0.001 

Yes 9 (2.2%) 350 (86.6%) 45 (11.1%)  

Food insecurity     

No 45 (2.9%) 1421 (91.7%) 84 (5.4%) 0.005 

Yes 23 (2.8%) 779 (94.7%) 21 (2.6%)  

Place of residence     

Urban 14 (1.9%) 660 (90.5%) 55 (7.5%) <0.001 

Rural 54 (3.3%) 1540 (93.7%) 50 (3.0%)  

Region of residence     

Southern 4 (1.5%) 252 (94.7%) 10 (3.8%)  

Southeastern 22 (4.4%) 451 (90.4%) 26 (5.2%)  

Central 7 (1.9%) 354 (93.7%) 17 (4.5%) 0.398 

Western 6 (2.2%) 248 (92.2%) 15 (5.6%)  

Mid-western 8 (2.6%) 285 (92.5%) 15 (4.9%)  

Northwestern 9 (3.0%) 278 (93.0%) 12 (4.0%)  

Eastern 12 (3.4%) 332 (93.8%) 10 (2.8%)  

Total 68 (2.9%) 2200 (92.7%) 105 (4.4%)  

 

  

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Table 4.3 Results of multivariable logistic regression analysis  

Variables 
Complementary feeding pattern 

            Any CFP (yes/no) Inadequate CFP               Adequate CFP 

 Adjusted  

OR (95% CI) 
P values 

Adjusted  

OR (95% CI) 

P 

values 

Adjusted  

OR (95% CI) 
P values 

Children age (months)       

6-11 0.55 (0.32-0.96) <0.001 0.57 (0.33-1.00) 0.050 0.22 (0.10-0.47) <0.001 
12-17 2.63 (1.14-6.07) 0.037 2.68 (1.16-6.19) 0.021 1.84 (0.72-4.71) 0.206 

18-23 (ref.) 1.00  1.00  1.00  

Sex of child       
Male 0.92 (0.56-1.49) 0.725 0.91 (0.56-1.50) 0.719 1.01 (0.54-1.89) 0.978 

Female (ref.) 1.00  1.00  1.00  

Mother’s education       

Illiterate 1.11 (0.52-2.37) 0.779 1.11 (0.52-2.35) 0.792 1.48 (0.46-4.69) 0.509 
Literate (ref.) 1.00  1.00  1.00  

Father’s education       

Illiterate 1.01 (0.54-1.89) 0.981 1.03 (0.55-1.92) 0.934 0.32 (0.11-0.95) 0.040 
Literate (ref.) 1.00  1.00  1.00  

Father’s employment status      

Currently unemployed 0.42 (0.08-2.25) 0.313 0.44 (0.08-2.36) 0.341 0.23 (0.02-2.12) 0.193 

Labours 0.94 (0.28-3.20) 0.918 0.98 (0.29-3.35) 0.976 0.49 (0.13-1.89) 0.297 
Service holders 0.68 (0.19-2.40) 0.551 0.70 (0.20-2.48) 0.584 0.50 (0.13-2.01) 0.330 

Businessman (ref.) 1.00  1.00  1.00  

Socioeconomic status       
Poor 0.85 (0.39-1.84) 0.539 0.86 (0.40-1.86) 0.704 0.55 (0.18-1.70) 0.299 

Middle 0.69 (0.35-1.34) 0.687 0.70 (0.36-1.37) 0.297 0.28 (0.09-0.86) 0.025 

Rich (ref.) 1.00  1.00  1.00  

Watch Television weekly       
No 0.89 (0.51-1.57) 0.695 0.90 (0.51-1.58) 0.712 0.68 (0.31-1.49) 0.336 

Yes (ref.) 1.00  1.00  1.00  

Listen radio weekly       

No 1.24 (0.55-2.81) 0.607 1.24 (0.55-2.81) 0.608 1.21 (0.42-3.44) 0.722 

Yes (ref.) 1.00  1.00  1.00  

Read newspapers/magazine weekly     

No 0.82 (0.38-1.77) 0.602 0.86 (0.40-1.85) 0.702 0.38 (0.16-0.92) 0.032 
Yes (ref.) 1.00  1.00  1.00  

Food insecurity       

No 0.83 (0.47-1.46) 0.526 0.83 (0.47-1.46) 0.518 0.90 (0.42-1.95) 0.796 
Yes (ref.) 1.00  1.00  1.00  

Place of residence       

Urban 1.43 (0.75-2.70) 0.275 1.40 (0.74-2.65) 0.300 1.93 (0.90-4.13) 0.090 

Rural (ref.) 1.00  1.00  1.00  

Region of residence       

Southern 2.40 (0.75-7.70) 0.276 2.40 (0.75-7.68) 0.141 2.84 (0.65-12.38) 0.164 

Southeastern 0.72 (0.34-1.49) 0.140 0.71 (0.34-1.47) 0.357 1.26 (0.44-3.58) 0.663 
Central 1.67 (0.64-4.34) 0.380 1.65 (0.65-4.30) 0.304 2.42 (0.69-8.45) 0.165 

Western 1.34 (0.49-3.73) 0.294 1.32 (0.48-3.66) 0.592 2.44 (0.66-9.01) 0.182 

Mid-western 1.19 (0.47-3.01) 0.570 1.17 (0.47-2.97) 0.735 2.03 (0.59-6.99) 0.263 
Northwestern 1.19 (0.48-2.92) 0.711 1.17 (0.48-2.88) 0.733 2.04 (0.58-7.13) 0.263 

Eastern (ref.) 1.00  1.00  1.00  

CI, 95% confidence interval  

 
  

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Table 4.4 Association between underweight and child feeding practice  

Variables Under Weight (n=2227) 
Underweight (No/Yes) (Binary logistic regression results) 

Prevalence P values (Chi 
square) B S.E. P values ORs 

95.0% C.I. 

Lower Upper 

Child feeding pattern         

No (ref) 13 (20.6%)     1.00   

Inadequate 675 (32.6%) 0.005 0.60 0.33 0.041 1.82 0.95 3.48 

Adequate 18 (19.6%)  0.23 0.49 0.585 1.26 0.54 2.93 

Children age (months)         

6-11 (ref) 197 (24.6%)     1.00   

12-17 246 (32.5%) <0.001 0.50 0.11 <0.001 1.65 1.31 2.09 

18-23 263 (39.4%)  0.76 0.12 <0.001 2.13 1.68 2.70 

Sex of child         

Male (ref) 357 (31.8%) 0.905    1.00   

Female 349 (31.6%)  -0.01 0.09 0.900 0.98 0.81 1.19 

Mother’s education         

Illiterate (ref) 160 (45.8%) <0.001    1.00   

Literate 546 (29.1%)  -0.08 0.14 0.573 0.92 0.69 1.22 

Father’s education         

Illiterate (ref) 239 (42.4%) <0.001    1.00   

Literate 467 (28.1%)  -0.10 0.12 0.392 0.90 0.70 1.14 

Father’s employment status         

Currently unemployed (ref) 11 (22.9%)    0.444 1.00   

Labours  546 (34.9%) <0.001 0.53 0.36 0.142 1.70 0.83 3.47 

Service holders 119 (24.9%)  0.43 0.37 0.250 1.53 0.73 3.20 

Businessmen 30 (21.9%)  0.43 0.41 0.296 1.54 0.68 3.50 

Socioeconomic status         

Poor (ref) 225 (49.1%)     1.00   

Middle 167 (38.7%) <0.001 -0.32 0.14 0.023 0.72 0.54 0.95 

Rich 314 (23.5%)  -0.76 0.14 <0.001 0.46 0.35 0.61 

Watch Television weekly         

No (ref) 365 (41.9%) <0.001    1.00   

Yes 341 (25.1%)  -0.28 0.11 0.010 0.75 0.60 0.93 

Listen radio weekly         

No (ref) 649 (31.9%) 0.498    1.00   

Yes 57 (29.5%)  -0.01 0.17 0.975 0.99 0.70 1.40 

Read newspapers/magazine weekly         

No (ref) 632 (34.1%) <0.001    1.00   

Yes 74 (19.7%)  -0.25 0.15 0.090 0.77 0.57 1.04 

Food insecurity         

No (ref) 394 (27.0%) <0.001    1.00   

Yes 312 (40.5%)  0.28 0.10 0.007 1.33 1.08 1.64 

Place of residence         

Urban (ref) 167 (24.1%) <0.001    1.00   

Rural 539 (35.1%)  0.14 0.11 0.229 1.15 0.91 1.44 

Region of residence         

Southern (ref) 84 (33.3%)     1.00   

Southeastern 152 (32.8%)  0.09 0.17 0.580 1.10 0.78 1.55 

Central 110 (30.7%)  -0.11 0.18 0.534 0.89 0.61 1.28 

Western 57 (22.1%) <0.001 -0.46 0.21 0.027 0.62 0.41 0.94 

Mid-western 80 (28.1%)  -0.26 0.19 0.184 0.76 0.52 1.13 

Northwestern 85 (30.6%)  -0.28 0.19 0.151 0.75 0.51 1.10 

Eastern 138 (41.6%)  0.35 0.18 0.061 1.42 0.98 2.05 

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Bangladesh Journal of Bioethics 2018; 9 (3): 28-44 

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hazards among female children compared to male 
36. . Regional variation also has been observed 

in terms of CFP. Variations in CFP may 

conceal important intra-regional differences 

due to diverse cultural norms and needs more 

investigation.       

 

Conclusion: The overall level of CFP 

among children is still low in Bangladesh and 

needs further improvement. The levels of 

CFP are found to be strongly associated with 

several individual, household and community 

factors. Some of these factors namely 

children’s age, father’s education, 

socioeconomic status, mass media exposure 

and place of residence are justified to be 

considered while developing strategies or 

interventions to address the issue of child 

CFP in Bangladesh. More studies are needed 

to assess the level of CFP in Bangladesh. 

 

Recommendations: Although numerous 

policies and strategies have been issued in 

Bangladesh to improve the IYCFP, some 

challenges such as insufficient resources and 

lack of coordination among stakeholders are 

impeding their implementation and 

enforcement.  

1. Strengthening of the existing strategies 

such as eradication of poverty through 

marginalized and vulnerable group 

development, empowering women to 

practice decision making autonomy and 

minimizing rural urban differential 

through planning and providing modern 

facilities are urgently necessary to 

improve the situation of CFP in 

Bangladesh.  

2. Proper CFP can also be ensured by 

undertaking social safety net program and 

community-based nutritional 

interventions, for example, food for 

education, food for work for slum 

dwellers and so on 28.   

3. The feeding practice of home-based 

foods with various textures should be 

encouraged 37. 

4. Health promotion program through cross-

collaboration among various 

organizations are needed to ensure proper 

CFP. 

5. Behavioral change communication 

through nutritional education, 

particularly in slum and rural areas, 

which support and educate mothers, need 

to be developed for improving 

appropriate feeding practice to children 
38,39. In addition, more efforts should be 

given to review existing nutritional 

interventions that target the IYCFP in 

Bangladesh.  

6. Longitudinal studies are recommended 

to determine the cause-effect 

relationships between plausible factors 

and CFP in Bangladesh.   

 

 

 

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32 

 

 

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Author contributions: 1st author    Naznin Pervin  

was involved in concept and design of the paper; 2nd 
and 3rd authors Darryl Macer and Shamima P. Lasker 

were equally involved in the literature search, review, 
compilation, manuscript writing and revision 
respectively. 

Conflict of interest: There is no conflict of interest 
relevant to this paper to disclose43 

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