Maternal knowledge and attitudes towards complementary feeding in relation to timing of its initiation in rural Bangladesh

BACKGROUND: Initiation of complementary feeding is often delayed in Bangladesh and likely contributes to the high burden of infant undernutrition in the country. METHODS: Pregnant women at 28–32 weeks’ gestation were recruited for a cohort-based evaluation of a community-based nutrition education program. To identify predictors of the timing of introduction of solid/semi-solid/soft foods (complementary feeding initiation), we prospectively interviewed 2078women (1042 from intervention area, 1036 from control area) at time of recruitment and at child age 3 and 9 mo. Maternal knowledge and attitudes towards complementary feeding, nutritional importance and cost of complementary foods were assessed at child age 3 months. Two scales were created from the sum of correct responses. Tertiles were created for analysis (Knowledge: 0–7, 8–9, 10–15; Attitudes: 18–25, 26, 27–34). Infant age at complementary feeding initiation was characterized as early (≤4 months), timely (5–6 months) or late (≥7 months), based on maternal recall at child age 9 mo. We used stratified polytomous logistic regression, adjusted for socioeconomic status, infant gender, maternal age, literacy and parity to identify predictors of early or late vs. timely complementary feeding initiation. RESULTS: Complementary feeding initiation was early for 7%, timely for 49%, and late for 44% of infants. Only 19% of mothers knew the WHO recommended age for complementary feeding initiation. The knowledge score was not associated with timely complementary feeding initiation. Mothers with the most favorable attitudes (highest attitudes score tertile) were more likely to initiate late complementary feeding compared to those with the lowest attitudes score tertile (adjusted OR = 2.2, 95% CI: 1.1–4.4). CONCLUSION: Late introduction of complementary foods is still widely prevalent in Bangladesh. Improved maternal knowledge or favorable attitudes towards complementary feeding were not associated with timely introduction of complementary foods, indicating other factors likely determine timing of complementary feeding initiation. This presents an avenue for future research.