Aims Sub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. We aimed to undertake a systematic review of studies assessing CFP in SA children aged 0– 2 years in Bangladesh, India and Pakistan.
Methods Searches undertaken between January 1990 to June 2016; MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity and Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CFP in SA children aged 0–2 years and/or their families. Search terms were: ‘children’, ‘feeding’ and ‘Asians’ with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).
Results From 45,712 studies identified, 126 descriptive studies (105 cross-sectional, 11 cohort, 8 qualitative, 1 case-control and 1 mixed studies) were included. 73 from India, 17 Pakistan and 36 Bangladesh. Despite each adopting WHO Infant and Young Children Feeding (IYCF) Guidelines, CFP were sub-optimal in all three countries.
In Pakistan, of 15 studies reporting CFP timings, 8 recorded timely initiation (between 6–9 months). Of those reporting dietary diversity, 3 of 9 studies met minimum dietary diversity requirements across 4 of 7 WHO IYCF food groups. 2 of 3 studies observed minimum meal frequency in over 50% of participants.
In India 35 of 59 studies reported timely initiation of CFP. 7 of 9 studies noted minimum dietary diversity achieved between 10%–23% of the study population. 5 of 15 studies noted minimum meal frequency achieved between 25%–96% of the study population.
In Bangladesh, in 13 of 36 studies timely initiation of CFP ranged from 42%–64%. 3 of 17 studies noted minimum dietary diversity achieved between 19.8%–57.7% of the study population. 1 of 7 studies noted minimum meal frequency achieved between 33%–81% of the study population.
Influencing factors included poor education about CFP, cultural beliefs and socioeconomic variables.
Conclusion This is the first SR to evaluate CFP in infants in India, Pakistan and Bangladesh. There is a great need for revision of nationwide child health programmes and campaigns to change health and nutrition behaviour.