Inadequate nutrition and development in the first thousand days have significant public health
implications which include long-term effects on cognitive development and school achievement.
Iron is one of the key nutrients needed for long-term growth and cognitive development. A strategy
to address poor nutrition in infancy is the use of various home fortification products for example
small-quantity lipid based nutritional supplements (SQ-LNS).
This study investigated the nutritional status, early feeding practices and psychomotor
development of 6-month-old infants from a peri-urban community in Klerksdorp (North West
Province), South Africa, as well as the acceptance of 2 novel SQ-LNS for complementary feeding
by infants and their primary caregiver.
The study used baseline data of a randomized controlled trial and had a cross-sectional design
that included 750 6-month-old infants from a peri-urban community in the North West province in
South Africa. Early feeding practices and dietary intake were investigated in association with
nutritional status and psychomotor development.
For the acceptability trial, mother/infant pairs were enrolled in a two-part trial. Part 1 (n= 16) was
a test-feeding trial with a cross-over, randomized design in which a five-point hedonic scale was
used for sensory evaluation (disagree= 1, agree= 5). Part 2 (n= 38) was a two-week, home-use
trial followed by focus group discussions.
For 48.9% of the infants, exclusive breastfeeding was ceased at the age of 0–2 months. Semisolid
and/or solid foods were introduced mostly at the age of 3–4 months. At the age of 6 months,
70.1% of infants were still being breastfed. Frequently consumed complementary foods were
mainly infant cereal (68.1%), formula milk (42.0%) and jarred infant foods (22.7%). Dietary intake
data showed that for more than 80% of the infants, the nutrient density (amount of nutrient per
100 kcal) for iron, zinc, and calcium of the complementary diet was lower than the desired density.
With regards to nutritional status, 36.4% of the infants were anaemic (Hb < 11 g/dl), 16.1% were
iron deficient (plasma ferritin concentration <12 μg/l), and 9.3% of the infants suffering from iron
deficiency anaemia. The anthropometric data showed that 29.3% of the infants were stunted (LAZ
< 2) and 10.1% were overweight (WLZ > 2). Binary logistic regression analysis showed that male infants had a greater chance of being
anaemic (OR= 1.388, p= 0.037). Infants who ceased being exclusively breastfed at the age of
0–2 months (OR=0.620, p=0.039) and infants who frequently consumed formula milk (OR=0.523,
p=0.001) had a lower chance of being anaemic. Regarding iron deficiency (ID) status, male
infants (OR=2.432, p=0.002) were found to have a greater chance to be ID; while infants with a
higher birth weight (OR=0.417, p=0.005), infants who ceased being exclusively breastfed at the
age of 0–2 months (OR=0.362, p=0.022), and infants who frequently consumed formula milk
(OR=0.219, p=0.001), had a lower chance to be ID.
Multivariate linear regression analysis showed that haemoglobin concentration was positively
related to eye-hand, locomotor and therefore also combined psychomotor activities [β= 0.677
(0.343, 1.011), p= < 0.001)]; [β= 0.439 (0.164, 0.714), p= 0.002]; [β= 1.116 (0.586, 1.645), p= <
0.001], respectively. Frequent consumption of infant cereal (≥4 days a week) was positively
related to locomotor development [β= 0.709 (0.043, 1.376), p= 0.037] and parent rating scores
[β= 1.506 (0.912, 2.100); p= < 0.001]. Exclusive breastfeeding up to age 0–2 months was related
to higher parent rating scores [β= 1.544 (0.673, 2.414), p = 0.001)] compared to exclusive
breastfeeding up to the age of 5–6 months. Male gender was associated with lower parent rating
scores [β= –0.673 (–1.256, –0.089), p = 0.024], compared to female infants.
Findings from the acceptability trial showed that more than 70% of mothers reported a score of
≥4 on sensory attributes for both of the small-quantity lipid-based nutritional supplements,
indicating that both supplements were well received. The mean reported consumption over the
two week period was 65.3±34.2% and 62.0±31.3% of the 20 g daily portion for supplement A and
B, respectively. Focus group discussions confirmed a positive attitude towards the supplements
in the study population.
The study provides evidence that feeding practices at a very young age, including breast feeding
practices, can have implications on nurtitional status and/or iron status with consequences on
infant development. Associations found between feeding practices and psychomotor
development may be explained by the iron status of the infants as a consequence of feeding
practices. It therefore emphasises the importance of adequate iron nutrition and iron status during