Trends in complementary feeding practices and caregivers’ feeding knowledge among children aged 6-23 months: Repeated cross-sectional surveys in rural Qinghai China 2012-18

BACKGROUND: Appropriate infant and young child feeding is the basis for child survival, growth and development. The aim of this study was to investigate trends in complementary feeding practices and caregivers’ feeding knowledge among children from 2012 to 2018 in Huzhu County, Qinghai Province, China. METHODS: This study took place during and after a controlled interventional evaluation trial in Qinghai Province, China, which aimed to evaluate the effectiveness of community-based nutrient-dense complementary food supplements (YingYangBao) combined with dietary counseling on improving 6-23 month-old children's health status. We conducted four representative cross-sectional surveys on caregivers of children aged 6-23 months in Huzhu County, Qinghai Province, China (baseline survey for the trial (N = 1804) in August 2012, end-line survey for the trial (N = 2186) in August 2014, follow-up survey 1 (N = 496) in January 2016, and follow-up survey 2 (N = 754) in July 2018). In all surveys we used the same questionnaire to collect household information, infant feeding practices and caregivers’ feeding knowledge. RESULTS: During the trial period (2012-2014), the proportion of children aged 6-8 months that introduced (semi-) solid food increased from 86.1% to 96.3% (P < 0.0001), however, there was a downward trend from 2014 to 2018 (P = 0.0014 for trend). The prevalence of minimum dietary diversity also increased from 51.4% at 2012 baseline survey to 57.5% at 2014 endline survey (P = 0.0004), but the upward trend did not maintain from 2014 to 2018 (P = 0.7863 for trend). The minimum dietary frequency, the minimum acceptable diet, and continued breastfeeding at one year were nearly unchanged from 2012 to 2018 (P = 0.9529, P = 0.7602 and P = 0.6013 for trend, respectively), remaining around 30%, 10% and 20% respectively in the four surveys. Caregivers’ feeding knowledge on the duration of exclusive breastfeeding and introduction of semi or solid foods at 6-8 months increased from 2012 to 2018 (18.6% to 39.5%, 43.2% to 64.3%, respectively). CONCLUSION: This study showed that the sustainability of community-based YYB and dietary counseling program was suboptimal. We suggest that multiple information delivery channels such as smartphones and the Internet should be explored as a supplement to existing channels for delivering counseling information. TRIAL REGISTRATION: ChiCTRPRC12002444.