Volume 95, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The complementary feeding period is an important time for children's growth and development. This study was conducted to 1) determine the feeding behaviors of 6- to 36-month-old children in Myanmar, 2) explore health effects of feeding behaviors, and 3) determine factors associated with feeding behaviors. A total of 807 children and their mothers ( = 642) were recruited from nine villages in Kachin, Shan, and Kokang, Myanmar. Feeding behaviors and sociodemographic characteristics were investigated using a validated questionnaire. Hemoglobin and anthropometric indicators were measured during the fieldwork. In our sample, 18.6%, 72.7%, and 9.8% of children were introduced to complementary foods (CFs) earlier than 4 months of age, between 4 and 8 months of age, and later than 8 months of age, respectively. For different types of CFs, up to the age of 24.1–36 months, there were still 6.5% and 4.1% of the children who had never been introduced to eggs and meat. Introduction of CFs earlier than 4 months of age was a risk factor for being underweight (age-adjusted odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.2–2.5) and for stunting (OR = 1.6, 95% CI = 1.1–2.3), whereas introduction of CFs later than 8 months of age was a risk factor for anemia (OR = 3.5, 95% CI = 1.7–7.2). Mothers who had anemia (OR = 3.7, 95% CI = 2.0–6.9) tended toward early introduction of CFs. Women with a lower family income tended toward later introduction of CFs (OR = 2.0, 95% CI = 1.3–3.3). This study demonstrated that inappropriate feeding behavior was one of the important causes of malnutrition.


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  1. Zaw PP, Htoo TS, Pham NM, Eggleston K, , 2015. Disparities in health and healthcare in Myanmar. Lancet 386: 2053.[Crossref]
  2. Htay TT, , 2007. Making pregnancy safer in Myanmar: introducing misoprostol to prevent post-partum haemorrhage as part of active management of the third stage of labour. Reprod Health Matters 15: 214215.[Crossref]
  3. Sein TT, Myint P, Tin N, Win H, Aye SS, Sein T, , 2014. The Republic of the Union of Myanmar: Health System Review. Geneva, Switzerland: World Health Organization.
  4. Beyrer C, Lee TJ, , 2008. Responding to infectious diseases in Burma and her border regions. Confl Health 2: 2.[Crossref]
  5. Taw NP, , 2015. The 2014 Myanmar Population and Housing Census. The Union Report: Census Report, Vol. 2. Nay Pyi Taw, Myanmar: Department of Population, Ministry of Immigration and Population.
  6. Zhao A, Gao H, Li B, Yu K, Win NN, Zhang Y, Wang P, , 2015. Potential contribution of iron deficiency and multiple factors to anemia among 6- to 72-month-old children in the Kokang area of Myanmar. Am J Trop Med Hyg 93: 836840.[Crossref]
  7. Zhao A, Zhang Y, Peng Y, Li J, Yang T, Liu Z, Lv Y, Wang P, , 2012. Prevalence of anemia and its risk factors among children 6–36 months old in Burma. Am J Trop Med Hyg 87: 306311.[Crossref]
  8. WHO, 1998. Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Available at: http://www.who.int/nutrition/publications/infantfeeding/WHO_NUT_98.1/en/. Accessed March 17, 2016.
  9. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW, , 1998. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316: 2125.[Crossref]
  10. Sultan AN, Zuberi RW, , 2003. Late weaning: the most significant risk factor in the development of iron deficiency anaemia at 1–2 years of age. J Ayub Med Coll Abbottabad 15: 37.
  11. Sarwar T, , 2002. Infant feeding practices of Pakistani mothers in England and Pakistan. J Hum Nutr Diet 15: 419428.[Crossref]
  12. Stevenson RD, Allaire JH, , 1991. The development of normal feeding and swallowing. Pediatr Clin North Am 38: 14391453.[Crossref]
  13. Mahalanabis D, , 1991. Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study. BMJ 31: 493496.[Crossref]
  14. Black RE, Morris SS, Bryce J, , 2003. Where and why are 10 million children dying every year? Lancet 361: 22262234.[Crossref]
  15. Saleh F, Ara F, Hoque MA, Alam MS, , 2014. Complementary feeding practices among mothers in selected slums of Dhaka city: a descriptive study. J Health Popul Nutr 32: 8996.
  16. WHO Multicentre Growth Reference Study Group, 2006 WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age. Methods and Development. Geneva, Switzerland: WHO Press.
  17. UNICEF, 1998. Preventing Iron Deficiency in Women and Children: Technical Consensus on Key Issues. Available at: http://www.inffoundation.org/pdf/prevent_iron_def.pdf. Accessed December 31, 2015.
  18. Young BE, Krebs NF, , 2013. Complementary feeding: critical considerations to optimize growth, nutrition, and feeding behavior. Curr Pediatr Rep 1: 247256.[Crossref]
  19. Ferguson EL, Darmon N, Fahmida U, Fitriyanti S, Harper TB, Premachandra IM, , 2006. Design of optimal food-based complementary feeding recommendations and identification of key “problem nutrients” using goal programming. J Nutr 136: 23992404.
  20. Ashenafi S, Meaza D, Yemane B, , 2013. Timely initiation of complementary feeding and associated factors among children aged 6 to 12 months in northern Ethiopia: an institution-based cross-sectional study. BMC Public Health 13: 1050.[Crossref]
  21. Issaka AI, Agho KE, Page AN, Burns PL, Stevens GJ, Dibley MJ, , 2015. Factors associated with early introduction of formula and/or solid, semi-solid or soft foods in seven francophone west African countries. Nutrients 7: 948969.[Crossref]
  22. Saha KK, Frongillo EA, Alam DS, Arifeen SE, Persson LA, Rasmussen KM, , 2015. Household food security and infant feeding practices in rural Bangladesh. Public Health Nutr 13: 17.
  23. Sawadogo SP, Yves MP, Claire MR, Alain B, Alfred TS, Serge T, Francis D, , 2010. Late introduction and poor diversity were the main weaknesses of complementary foods in a cohort study in rural Burkina Faso. Nutrition 26: 746752.[Crossref]
  24. Saaka M, Wemakor A, Abizari AR, Aryee P, , 2015. How well do WHO complementary feeding indicators relate to nutritional status of children aged 6–23 months in rural northern Ghana? BMC Public Health 15: 1157.[Crossref]
  25. Mei Y, Hu LH, Liu JT, , 2013. Introduction of complementary food in rural areas of Yunan, China. Soft Science of Health 27: 174176.
  26. Scott JA, Binns CW, Graham KI, Oddy WH, , 2009. Predictors of the early introduction of solid foods in infants: results of a cohort study. BMC Pediatr 9: 60.[Crossref]
  27. Qasem W, Fenton T, Friel J, , 2015. Age of introduction of first complementary feeding for infants: a systematic review. BMC Pediatr 15: 107.[Crossref]
  28. Simondon KB, Simondon F, , 1997. Age at introduction of complementary food and physical growth from 2 to 9 months in rural Senegal. Eur J Clin Nutr 51: 703707.[Crossref]
  29. Pande S, Keyzer MA, Arouna A, Sonneveld BG, , 2008. Addressing diarrhea prevalence in the West African Middle Belt: social and geographic dimensions in a case study for Benin. Int J Health Geogr 7: 17.[Crossref]
  30. Kimmons JE, Dewey KG, Haque E, Chakraborty J, Osendarp SJ, Brown KH, , 2005. Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr 135: 444451.
  31. Zhao A, Ning Y, Zhang Y, Yang X, Wang J, Li W, Wang P, , 2014. Mineral compositions in breast milk of healthy Chinese lactating women in urban areas and its associated factors. Chin Med J (Engl) 127: 26432648.
  32. Baker RD, Greer FR, , 2010. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 126: 10401050.[Crossref]
  33. WHO, 2010. Indicators for Assessing Infant and Young Child Feeding Practices. Part 2: Measurement. Geneva, Switzerland: The World Health Organization.
  34. WHO, 2007. Indicators for Assessing Infant and Young Child Feeding Practices. Part 1: Definitions. Washington, DC: Department of Child and Adolescent Health and Development, World Health Organization.
  35. WHO, 2015. Health Topics: Breastfeeding. Available at: http://www.who.int/topics/breastfeeding/en/. Accessed December 31, 2015.
  36. UNICEF, 2013. Breastfeeding on the Worldwide Agenda: Findings from a Landscape Analysis on Political Commitment for Programmes to Protect, Promote and Support Breastfeeding. Available at: http://www.unicef.org/eapro/breastfeeding_on_worldwide_agenda.pdf. Accessed October 7, 2014.
  37. Anand T, Rahi M, Sharma P, Ingle GK, , 2014. Issues in prevention of iron deficiency anemia in India. Nutrition 30: 764770.[Crossref]
  38. Zhao AL, Zhang Y, Li B, Wang P, Li J, Xue Y, Gao H, , 2014. Prevalence of anemia and its risk factors among lactating mothers in Myanmar. Am J Trop Med Hyg 90: 963967.[Crossref]
  39. Semahegn A, Tesfaye G, Bogale A, , 2014. Complementary feeding practice of mothers and associated factors in Hiwot Fana Specialized Hospital, eastern Ethiopia. Pan Afr Med J 18: 143.[Crossref]
  40. Saleem AF, Mahmud S, Baig-Ansari N, Zaidi AK, , 2014. Impact of maternal education about complementary feeding on their infants' nutritional outcomes in low- and middle-income households: a community-based randomized interventional study in Karachi, Pakistan. J Health Popul Nutr 32: 623633.
  41. Bascom EM, Napolitano MA, , 2015. Breastfeeding duration and primary reasons for breastfeeding cessation among women with postpartum depressive symptoms. J Hum Lact 32: 282291.[Crossref]
  42. McInnes RJ, Hoddinott P, Britten J, Darwent K, Craig LCA, , 2013. Significant others, situations and infant feeding behaviour change processes: a serial qualitative interview study. BMC Pregnancy Childbirth 13: 114.[Crossref]

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  • Received : 07 Jan 2016
  • Accepted : 20 Apr 2016

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