title: Poor complementary feeding practices and high anaemia prevalence among infants and young children in rural central and western China.
abstract: OBJECTIVE
  Infant and young child feeding (IYCF) has not been documented in central and western China, where anaemia is prevalent. To support policy advocacy, we assessed IYCF and anaemia there using standardized methods.
  
  
  METHODS
  A community-based, cross-sectional survey of 2244 children aged 6-23 months in 26 counties of 12 provinces. Analysis of associations between haemoglobin concentration (HC), IYCF indicators and other variables using crude and multivariate techniques.
  
  
  RESULTS
  Only 41.6% of those surveyed consumed a minimum acceptable diet. Fewer still-breastfeeding than non-breastfeeding children consumed the recommended minimum dietary diversity (51.7 versus 71.9%; P<0.001), meal frequency (57.7% v. 81.5%; P<0.001) or iron-rich food (63.3% v. 78.9%; P<0.001). Anaemia (51.3% overall) fell with age but was significantly associated with male sex, extreme poverty, minority ethnicity, breastfeeding and higher altitude. Dietary diversity, iron intake, growth monitoring and being left behind by out-migrating parents were protective against anaemia. A structural equation model demonstrated associations between IYCF, HC and other variables. Meal frequency, iron intake and altitude were directly and positively associated with HC; dietary diversity was indirectly associated. Health service uptake was not associated. Continued breastfeeding was directly associated with poor IYCF and indirectly with reduced HC, as were having a sibling and poor maternal education.
  
  
  CONCLUSIONS
  Infant and young child anaemia is highly prevalent and IYCF is poor in rural central and western China. Continued breastfeeding and certain other variables indicate risk of poor IYCF and anaemia. Major policy commitment to reducing iron deficiency and improving IYCF is needed for China's rural poor.
authors.affiliation: 1] Health Section, UNICEF, New York, NY, USA [2] Health, Nutrition and WASH Section, UNICEF Office for China, Beijing, China.
authors.forename: D B
authors.initials: DB
authors.lastname: Hipgrave
authors.affiliation: Health, Nutrition and WASH Section, UNICEF Office for China, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Fu
authors.affiliation: Division of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
authors.forename: H
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Health, Nutrition and WASH Section, UNICEF Office for China, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Division of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Health, Nutrition and WASH Section, UNICEF Office for China, Beijing, China.
authors.forename: S
authors.initials: S
authors.lastname: Chang
authors.affiliation: Health, Nutrition and WASH Section, UNICEF Office for China, Beijing, China.
authors.forename: R W
authors.initials: RW
authors.lastname: Scherpbier
authors.affiliation: Division of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Health, Nutrition and WASH Section, UNICEF Office for China, Beijing, China.
authors.forename: S
authors.initials: S
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000531:Altitude; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology*; D001942:Breast Feeding; D002648:Child; D002681:China / Q000453:epidemiology; D004032:Diet / Q000592:standards*; D004641:Emigration and Immigration; D005190:Family; D005247:Feeding Behavior; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000592:standards*; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage*; D008297:Male; D015995:Prevalence; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary