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Determinants of dietary intake and dietary adequacy for pre-school children in Bangladesh

Rafiqul Huda Chaudhury
Bangladesh Institute of Development Studies, Dhaka, Bangladesh

INTRODUCTION

To evolve an appropriate policy to combat the malnutrition problems of children it is essential to assess not only the magnitude of the problem but also the factors affecting it. The nutritional status of an individual is the outcome of a complex interaction of a broad range of host and environmental factors, with the latter encompassing physical, biological, and especially cultural influences. In this paper an attempt is made to examine the relative importance of some socio-economic and demographic factors that affect the dietary intake of preschool children (0-4 years) in a rural area of Bangladesh. The factors included in the model are: per capita expenditure on food per day, parental education, family size, number of children in the age group 0-6 years (i.e. spacing), age and sex of the child.

Hypotheses

The expected relationship between each of the above variables and dietary intake and dietary adequacy of preschool children is discussed below.

Per Capita Expenditure on Food

Expenditure on food is a mirror image of a household's income and resources. One important reason for using per capita expenditure on food instead of per capita income is the non-linear relationship between income and calorie intake. The elasticity of income on food expenditure is usually less than one, particularly for higher income groups. With improvement of household income, absolute expenditure on food is likely to go up, as is the calorie and protein intake of the household, including children (1). However, if the household has limited purchasing power, not only may the per capita intake be less, but also the deficits are likely to be borne disproportionately by the children. This is truer in a peasant society like that in Bangladesh, where children are considered less important than adults, particularly male bread-earners. As a result, the nutritional status of children is likely to be more adversely affected than that of other members of the family with the decline of per capita expenditure on food. A positive relationship between per capita expenditure on food and dietary intake and dietary adequacy for children would be expected.

Education

The relationship between parental education and dietary intake of pre-school children is a complicated one. On one hand, more education is associated with greater awareness of children's needs and better child-care practices. Better educated parents should be able to provide their children with a more nutritious diet at any income level because of their increased knowledge. On the other hand, higher education may promote values detrimental to child health and nutrition. For example, it may lead women to work outside the home with a resulting drop in time spent on child care. This may lead to reduced breast-feeding and earlier weaning (2). When associated with improper use of bottled milk and inadequate feeding, the effects on health and nutrient intake of children can be extremely damaging (2). Data from another study also show that nutrient intake of pre-school children of working mothers is significantly lower than that of children of non-working mothers, holding other factors constant. In view of these counteracting effects of education on nutrient intake, the effect of parental education on nutrient intake of preschool children is difficult to predict.

Family Size

Increased family size may adversely affect the nutritional status of every member of the household, including preschool children, because it may be associated with decreased per capita human inputs. In other words, the allocation of food per child is likely to decrease with the increase in the number of children, which, in turn, may adversely affect the nutritional status of children. Increased household size also implies acceptance of lower quality/ quantity models of fertility decision. On the other hand, in some situations, as in Bangladesh, family size may itself point to a higher economic status of the household. In this case, larger family size may not lead to worsening of nutrient intake of household members and children. One may also note economies of scale in nutrition because of less waste and the possibility to purchase in bulk associated with larger family size. It should be further pointed out that it is not family size per se but the number of adults relative to children in a household that is the crucial factor influencing nutrient intake of children. In other words, the lower the dependency ratio, the higher the nutrient intake of pre-school children.

Number of Young Siblings (0-6 Years), or Birth Spacing

The presence of many young siblings-i.e. the occurrence of close birth intervals-may have an adverse effect on the nutrient intake and nutritional status of pre-school children for a variety of reasons:
- Nursing children are likely to be displaced earlier from the breast with the birth of a closely spaced sibling.
- Closer birth intervals make a mother nutritionally more vulnerable, which may affect both quality and quantity of breast-milk.
- A child in a family with a large number of siblings under 6 is likely to receive less food because the entire family may be short of food

Sex

In traditional patriarchal societies like that in Bangladesh, male children are considered more valuable than female for a variety of reasons: they are seen as an important source of labour on the family farm; they are expected to provide economic and social security for their parents when the father is old or incapacitated and in times of distress; also, the family name is carried on by sons 13). For these various social and economic reasons, there is a definite preference for male children in Bangladesh. Therefore, a higher nutrient intake for male children compared to female intake would be expected. This will be measured by introducing sex dummies in the model.

Age

There is likely to be a trend in nutrient adequacy in a child's early years. During the first year of life, an infant is likely to satisfy his/her nutrient needs mainly through breast-feeding and some complementary food. However, the nutrient adequacy (i.e. intake relative to need) for a child may fall drastically after the first year of life when breast-feeding no longer meets nutrient needs and complementary food is inadequate. This trend will be examined by introducing age dummies into the model. This will provide an opportunity to test how a child fares in satisfying calorie needs beyond the first year of life.

Dependent Variables

The major dependent variables used in the study are (a) actual nutrient (calorie/protein) intake per day per person and (b) mean nutrient adequacy ratio (NAR). This NAR is the ratio of the nutrient (calorie/protein) intake of an individual divided by the recommended daily allowance for calories and protein, respectively, times 100. This measures whether a child is consuming more, less, or the equivalent of need.

The child's nutrient needs are determined by two methods, both based on recommendations of the 1973 FAD/WHO report Energy and Protein Requirements (4). In order to ensure comparability of the findings of the present study with those of others conducted in Bangladesh (5-7), method A uses age-sex-specific recommendations. These recommendations are adopted both to allow for full potential growth of a child and to provide extra calories and protein to compensate for losses caused by infectious and parasitic diseases widely prevalent in rural Bangladesh. For comparison purposes, method B is based on age-sex/ average-weight-specific recommendations of the same report, using the mean weights reported from another study in a rural Bangladesh population (5).

Data

The data employed in this study were collected from 572 members of 108 households in the village of Muyiarchar, approximately 220 miles north-east of Dhaka, in Sylhet District. The sample included 50 per cent of the village households selected from various socio-economic groups, classified on the basis of land holdings and income. There were 99 household members in the age group birth to 4 years. Of these, 6, 41, and 52 were in the age groups birth to 6 months, 7 months to 2 years, and 3 to 4 years, respectively. The data collected included consumption of rice, wheat, fish, milk, meat, pulses, eggs, vegetables, and fruits per person per day and the sources and costs of food consumed. The data were collected for each member of the household once a month over a period of one year (August 1978 to July 1979) by 24-hour-recall interview. Mothers provided the information on food consumption by children. Interviewers were locally recruited and were mostly teachers from a nearby elementary school.

Individual food intake was converted into nutrient (calories and protein) intake by employing the Indian Food Composition Table (8). In addition to nutrient intake obtained from different sources of food, children, particularly those from birth to 2 years, are also expected to receive nutrients from breast-milk. Breast-feeding is a universal practice in Bangladesh, and it commonly extends beyond the second year of life and may be as long as four years (5). Brown and co-workers (9), in a longitudinal study of the actual amount of breast-milk being ingested by infants in another rural area of Bangladesh, found very little change during the first two years of life. Unfortunately, in this study the actual intake of breast-milk by infants was not measured. However, on the basis of data on actual milk production of lactating mothers obtained from rural areas of Bangladesh (9), we have added to our estimated intake 750 calories and 17 grams protein per day per person for infants 1 year old or less and 550 calories and 11 grams of protein per day per child for those between the ages of 1 and 2. Assuming an 80 per cent efficiency of conversion of food energy, the children are actually receiving from breast-milk an average of 600 and 440 calories per day per child, respectively. Protein intake was corrected for 70 per cent utilization (4).

FINDINGS

The findings are presented in two parts, the first part providing an overall picture of nutrient adequacy of preschool children and the second part examining the factors affecting nutrient intake and nutrient adequacy of preschool children in a regression model.

TABLE 1. Mean Calorie Adequacy Ratio by Age of Children

Age (years) No. of Cases Mean Calorie Adequacy Ratio
Method A* Method B**
< 1 13 93.50 150.98
1-2 12 52.17 101.84
2-3 22 60.41 122.22
3-4 52 66.67 101.05
0-4 99 67.0 112.41

* Calorie intake divided by caloric need, based on age-sex-specific recommendations of the 1973 FAD/WHO Report (4) multiplied by 100.
** Calorie intake divided by caloric need, based on weight-specific recommendations of the 1973 FAD/WHO Report (4) multiplied by 100.

TABLE 2. Calorie Adequacy Ratios of Pre-school Children (0-4 Years) by Socio-economic Characteristics of Households and Children's Age Groups

Socio-economic Characteristics of Household Method A Method B
All
children
0-4 yrs
Age group (years) All
children
0-4 yrs
Age group (years)
< 1 1-2.99 3-4.99 < 1 1-2.99 3-4.99
Landholding status
landless 64 95 57 64 109 153 113 98
< 1.0 acre 68 69 62 72 114 111 123 109
1 -2.5 acres 68 116 62 64 109 187 124 96
> 2.5 acres 73 116 54 72 121 188 110 107
Per capita income
<Tk 149 53 62 46 55 89 90 93 84
Tk 149-225.9 69 92 60 68 114 148 120 100
Tk 226-612.9 69 97 57 66 115 156 113 99
Tk 613 72 106 52 73 119 160 107 109
Education of head of household
illiterate 66 80 61 65 110 129 121 99
primary 70 122 45 69 115 197 91 104
primary 60 - 55 65 103 - 109 98
grade 6 76 97 64 74 129 156 156 130
Family size
1 -4 59 71 51 57 99 115 104 86
5-7 63 94 60 60 107 153 118 91
8 74 106 56 77 123 171 114 117
Family type
nuclear 66 101 56 66 112 164 112 100
joint 56 89 59 68 114 143 117 103
other 66 - - - 112      

A dash indicates that the data in question were not computed because of the small number (<= 3) of cases.

The Overall Situation Calories

Table 1 presents data on the caloric adequacy ratio of preschool children, calculated according to methods A and B. The overall calorie intake relative to energy needs of children in the study village is low, particularly when the caloric adequacy for a child is calculated by method A. According to method A, the intake of a child in the age group 0-4 years falls 33 per cent short of the calorie requirement on average. However, this situation changes when the energy needs are calculated by method B. which shows that a child 0-4 years old consumes on average 12 per cent more calories than the requirement.

The overall pattern of caloric adequacy for pre-school children obtained by methods A and B remains almost constant, even when we look at this within different background characteristics of the household, measured in terms of land-holding status, per capita income, education of head of the household, family size, and family type (see table 2). However, there is one major exception: in households having the lowest per capita income (less than Tk 149* per month), pre-school children do not meet their calorie requirements even when their needs are assessed by method B.

The Percentage of Children Who Fail to Meet Caloric Requirements

The average caloric adequacy ratio does not necessarily show the actual picture. Even when average intake exceeds requirement, a significant proportion of the population may be far short of required intake. This is shown in table 3, which presents data on the percentage of children who failed to meet calorie requirements according to methods A and B.

The data in table 3 show that 92 per cent of pre-school children have a calorie intake inadequate to meet their energy needs according to method A. The comparable figure according to method B is only 40 per cent. Even those fortunate few who meet their calorie requirement according to method A are mostly concentrated among those under 1 year. The percentage of infants who failed to meet calorie requirements according to method B is also lowest. This may be attributed to the effect of breast feeding, which is considered to be adequate to meet the nutrient needs of infants during the early months of life. In all other age categories, the percentage of children failing to meet calorie requirement reaches 100 per cent, or a little under, according to method A. According to method B. the percentage of children failing to meet caloric needs never goes beyond 58, and this is concentrated among the oldest pre-school children (3-4 years).

TABLE 3. Percentage of Pre-school Children (0-4 Years) Who Fail to Meet Calorie Requirement, by Age

Age Group (years) Method A Method B
n % n %
< 1 13 61.54 13 7.69
1-2 12 100.00 12 41.66
2-3 22 100.00 22 18.18
3-4 52 94.42 52 57.69
0-4 99 91.92 99 40.40

The question arises as to which of the two measures provides a realistic picture of the nutritional situation of children in rural Bangladesh. Although there may not be any correlation between calorie adequacy and nutritional status, the picture obtained by method A may provide a close approximation of the nutritional status of pre-school children in rural Bangladesh. This could be verified by data collected from rural areas on several dimensions of child nutritional status, particularly those based on anthropometric measurements. According to the Nutrition Survey of Rural Bangladesh, 1975/76 (6), nearly 74 per cent of the children aged 0-4 years were chronically undernourished (i.e., stunted or low height for age). Using the Gomez classification (weight for age), the same study also found that nearly 80 per cent of pre-school children (0-4 years) suffered from second- and third-degree malnutrition combined, and only 1 per cent of the children were normal (6). From these findings, one may conclude that caloric needs measured on the basis of age-sex-specific recommendations of the 1973 FAO/WHO report (4) may provide a more realistic picture of the nutritional status of pre-school children than when needs are measured on the basis of age-sex/average-weight-specific recommendations of the report, at least in the context of developing countries like Bangladesh.

Protein

With regard to protein intake, children seem to satisfy their requirements, whether this need is assessed by method A or B. The protein adequacy ratio always exceeds at least 100 at each age group of pre-school children with either method. Only 6 of 99 children (i.e. 6 per cent) and 1 of 99
(1 per cent) according to methods A and B. respectively, failed to satisfy their protein requirements.

Determinants of Nutrient Intake and Nutrient Adequacy Ratio of Pre-school Children

The discussion so far has dealt with the overall nutritional situation for pre-school children. Next will be an examination of the socio-economic and demographic factors, postulated earlier, affecting nutrient intake and adequacy pre-school children.

Multiple regression analysis is employed to measure the net effect of each of the variables in the model on dietary intake and dietary adequacy of pre-school children. Regression analysis in this case would be expected to identify the effects of each of the contributory variables in the equation, that is, holding other factors constant. The functional forms of the relationships are expressed in the following two equations.

1. Effect of socio-economic and demographic variables on dietary intake of pre-school children:

Dj = boj + bijSES

TABLE 4. Factors Affecting Dietary Intake and Dietary Adequacy Ratio of Pre-school Children (0-4 years) in a Rural Area of Bangladesh: Regression Analysis (OLS), N = 99

  Dependent Variables
Independent Variables Calorie intake per person per day Protein intake per person per day Adequacy ratio (method B)*
Calorie Protein
Age        
0-11 months        
1-2.99 years 23.42 3.11 - 22.41 - 217.45
(0.50) (2.25)c (-3.41 )d (-11.03)e
3-4.99 years 207.53 6.15 - 33.36 - 417.72
(3,59)e (3.62)d (-4,14)e (-16.47)e
Sex        
male - - - -
female 30.83 0.63 7.22 20.16
(1.15) (0.80) (1.93)b (1 90)b
Education of mother -16.98 1.90 - 1.14 37.03
(- 0.43) (1.63)a (- 0.21) (2 35)c
Education of father 14.73 - 0.56 2.08 - 15.37
(1.05) ( - 1.37) (1.07) ( - 2.78)c
Expenditure per capita on food (in take) 270.40 9.81 16.44 1.83
(10.31)e (12.73)e (4.49)e (0.13)
Household size 21.47 0.35 2.56 - 1.76
(3.07)d (1.69)8 (2.62)c ( - 0.63)
Number of children 0-6 years -5.60 - 0.21 - 0.92 - 0.97
( - 1.07) ( - 1.35) ( - 1.26) ( - 0.47)
R2 88.63 91.42 36.80 79.21

Figures in parentheses are "t" values. A dash indicates that the data in question are omitted. Nutrient (calorie/protein) intake divided by nutrient need, based on weight-specific recommendations of the 1973 FAO/WHO report (4) multiplied by 100.
a. Significant at the .10 level.
b. Significant at the .05 level.
c. Significant at the 01 level.
d. Significant at the .001 level.
e. Significant at the .0001 level.

2. Effect of socio-economic and demographic variables on dietary adequacy of pre-school children:

An = bon + BjnSES

where
D = average dietary intake of pre-school children
j = intake of calories/protein
A = average adequacy ratios of pre-school children
n = calorie/protein adequacy ratios
SES = a vector of household socio-economicum-demographic variables and age-sex composition of children

The net effect observed for each of these variables in dietary intake and dietary adequacy ratios is given in table 4 for pre-school children 0-4 years as a whole.

Dietary adequacy ratios employed as dependent variables in table 4 and those in tables 5 and 6 are based on method B. However, the conclusions are the same even when dietary adequacy calculated by method A as the dependent variable is employed. The operational definition of each of the independent variables used in the regression model is provided in the appendix.

Table 4 shows the following major findings: Dietary intake increases with age as expected. However, calorie adequacy ratio declines as the child advances in age. This may be attributed to the diminished capacity of breast-feeding to meet the calorie needs of a growing child and insufficient intake of complementary solid food. Also, a child at this stage cannot successfully compete with other household members for the family food.

Contrary to expectations, dietary adequacy ratios were consistently higher for females than for males. This relationship between sex and nutrient intake and adequacy ratios holds true for pre-school children (0-4 years) as a whole (table 4) and for children of various ages (tables 5 and 6) These findings do not support the hypothesis that male children are favoured over female children in the intra-familial distribution of food.

Parental education, particularly the father's education, appears to have very little effect on dietary intake and dietary adequacy of preschool children in rural Bangladesh. However, the mother's education has a positive effect on protein intake and the protein adequacy ratio for preschool children as a whole (table 4) and for the majority of children of all ages (table 6). This relationship is found to be statistically significant for the group as a whole and at least for the youngest children, i.e. those in the first year of life. The mother's education, in contrast, is negatively associated with calorie intake and calorie adequacy ratio for the group as a whole (table 4), and for the majority of other age groups (table 5) with the sole exception of infants. The mother's education has a significant and positive effect on calorie intake of children in the first year of life.

TABLE 5. Factors Affecting Calorie Intake and Calorie Adequacy Ratio of Pre-school Children (0-4 years) by Age in Rural Bangladesh: Regression Analysis (OLS)

Independent Variables Calorie Intake per Person per Day Calorie Adequency Ratio (Method B)
1 yr
N = 25
> 1-2.99 yr
N = 22
3-4.99 yr
N = 52
1 yr
N = 25
> 1-2.99 yr
N = 22
3-4.99 yr
N = 52
Male - - - - - -
Female 0.51 17.41 8.28 6.95 8.19 6.44
(0.05) (0.34) (0.18) (0.42) (1.55) (2.32)b
Education of mother 37.81 - 1.78 - 93.75 - 21.42 - 0.35 - 6.30
(1.82)a (- 0.02) (- 1.36) (- 0.70) (- 0.04) (- 1.48)
Education of father 6.49 - 0.92 17.85 5.97 - 0.08 1.23
(1.47) ( - 0.98) (0.68) (0.91) ( - 0.02) (0.76)
Expenditure per capita per day on food (in take) 58.89 110.68 284.55 - 23.17 11.89 16.15
(4.14)e (2.29)b (6.93)e ( - 1.09) (2.35)b (6.35)e
Household size 5.02 3.69 28.35 5.77 0.35 2.03
(1.91)b (0.40) (2.26)b (1.48) (0 30) (2.62)c
Number of children 0-6 years - 2.23 - 6.80 - 3.68 - 0.92 - 0.68 - 0.24
(- 0.79) (-0.83) (-0.43) (-0.22) (-0.78) (-0.45)
Age at introduction of solid food -10.22 - - - 4.28 - -
(-13.09)e     (-3.68)d    
Constant 825.99 366.14 78.34 332.80 34.88 6.26
R2 97.69 35.63 67.68 61.76 45.78 69.06

See notes for table 4.

TABLE 6. Factors Affecting Protein Intake and Protein Adequacy Ratio of Pre-school Children (0-4 years) by Age in Rural Bangladesh: Regression Analysis (OLS)

Independent Variables Protein Intake per Person per Day Protein Adequacy Ratio (Method B)
1 yr > 1-2.99 yr 3-4.99 yr 1 yr > 1-2.99 yr 3-4.99 yr
N = 25 N = 22 N = 52 N = 25 N = 22 N = 52
Male
Female 0.60 1.75 - 0.47 51.28 46.45 4.34
(0.45) (1.22) ( - 0.47) (1.43) (2.97)c (0.75)
Education of mother 5.96 1.10 - 1.56 140.90 10.66 - 17.12
(2.39)b (0.51) ( - 1.03) (2.10)b (0.45) (- 1.92)b
Education of father - 0.50 - 0.41 - 0.17 - 16.18 - 3.83 1.22
( - 0.94) ( - 0.40) ( - 0.30) ( - 1.13) ( - 0.33) (0.36)
Expenditure per capita per day on food (in take) 4.06 7.44 9.73 68.46 78.59 46.00
(2.37)b (5.45)e (10.73)e (1.48) (5.26)d (8.81)e
Household size 0.25 - 0.56 0.50 5.47 - 6.06 2.96
(0.77) ( - 1.82)a (1.81)a (0.64) (-1.79)a (1.82)a
Number of children 0-6 years - 0.44 - 0.04 - 0.08 - 6.78 - 0.62 - 0.94
( - 1.29) ( - 0.17) ( - 0.43) ( - 0.75) ( - 0.24) ( - 0.84)
Age at introduction of solid food - 0.39 - 9.29
(- 4.15)d     (—3.67)d    
Constant 29.70 16.38 9.51 714.83 157.59 53.46
R2 86.82 72.15 80.21 81.74 76.13 75.12

This picture changes when the effect of the father's education on dietary intake and dietary adequacy of pre-school children is analysed. The father's education is positively associated with calorie intake and calorie adequacy ratio. The father's education has a negative influence on protein intake and the protein adequacy ratio, and these relationships hold true for pre-school children as a whole (table 4) and for the majority of children of all ages (tables 5 and 6). It should be noted that in none of the cases was the effect statistically significant. The effect of the mother's education on dietary intake is consistently significant and positive, at least for infants. One implication of these findings is that, given the same amount of education, the mother's education will have a more positive effect then the father's education on the dietary intake of infants. Beyond this age, factors other than the mother's education possibly play more important roles in determining dietary intake of pre-school children. However, present findings of a weak and inconsistent relationship between parental education and dietary intake or dietary adequacy of preschool children should not detract from the positive role of education, particularly maternal education, on nutrient intakes of pre-school children. The weak relationship observed here may result from lack of variability in education score. The majority (more than 90 per cent) of the parents in this study have had no formal education. For a better test of the effect of education on nutrient intake there should be wider variation in education level.

Per capita expenditure on food is found to be an important factor determining the calorie and protein intake and also calorie adequacy ratio of pre-school children. Per capita expenditure of one take a day on food is associated with the intake of 270 calories, 10 grams of protein, and a 16 per cent increase in the caloric adequacy ratio of preschool children. These increases are significantly different from zero. Protein adequacy of a pre-school child also improves with per capita expenditure on food, but this change is not significantly different from zero (table 4).

The positive and also significant effect of per capita food expenditure on nutrient intake and the nutrient adequacy ratio is also found in each age group of children, with the exception of the youngest (i.e. infants) who are breast-fed (see tables 5 and 6). Per capita food expenditure has a negative effect on calorie adequacy ratio but a positive impact on protein adequacy ratio during the first year of life. However, these relationships are not significantly different from zero. It therefore shows that the level of family food expenditure per capita is not a crucial factor in determining nutrient adequacy for an infant. However, for older children, family food expenditure per capita is the main factor determining nutrient intake and nutrient adequacy.

Household size shows a positive and significant relationship with calorie intake and calorie adequacy ratio for the sample of pre-school children as a whole (table 4). This relationship is also positive, but not significantly different from zero for children of various ages (table 5).

The positive association between household size and calorie intake is found to be significant for the youngest and oldest pre-school children, but the calorie adequacy ratio was found significant only for the oldest pre-school children (table 5). Household size also shows a significant and positive association with protein intake, though it has a negative, but insignificant, impact on the protein adequacy ratio for preschool children as a whole (table 4). However, the negative association between household size and protein intake and the protein adequacy ratio is found to be negative only for children 1 to 2 years old. In other age categories this association is found to be positive but only significant for the oldest pre-school children (see table 6) The overall positive association between household size and nutrient intake possibly reflects the greater household wealth often associated with household size and also economies of scale in larger households.

Table 7 also suggests that it is not the household size per se but the dependency ratio within a household that plays an important role in determining the nutrient intake of preschool children. Holding household size constant, there is a positive association between nutrient intake of children and the number of adult units in the household. In other words, the higher the dependency ratio, the lower the nutrient intake of pre-school children.

The number of young siblings 0-6 years old, or close birth intervals, consistently shows an inverse though insignificant relationship with nutrient intake and nutrient adequacy ratio for the entire sample of children of all ages (tables 4 to 6). This finding confirms that frequent births have a small but detrimental effect on nutrient intake and the nutrient adequacy ratio of pre-school children.

In addition to the above explanatory variables, the timing of the introduction of solid food was also examined for its effect on nutrient intake and nutrient adequacy for children of weaning age. Timing of solid food for breast-fed children is a crucial factor in determining nutritional status. The longer the child goes without solid food, the worse the effect on height and weight (10). Data from this study also show a negative association between timing of introduction of solid food and nutrient adequacy ratios of infants (see tables 5 and 6). A one-month delay in introducing solid food is associated with 4 per cent and 10 per cent reduction of calorie and protein adequacy ratios of infants, respectively. These reductions are significantly different from zero.

OVERVIEW, DISCUSSION, AND POLICY IMPLICATIONS

The findings in this study clearly show that the calorie intake of a sizeable proportion of pre-school children falls short of estimated energy requirements whether the need is assessed according to age, sex, and average weight(method B) or simply and age and sex (method A). When the need is assessed under the most logical assumption, i.e. by method B. at least 40 per cent of pre-school children fail to meet their calorie requirement, and this figure rises to 92 per cent when the energy needs are assessed by age-sex requirement regardless of weight (method A). This low calorie adequacy ratio is an important factor contributing to the poor nutritional status and high mortality among pre-school children in rural Bangladesh.

TABLE 7. Dietary Intake and Dietary Adequacy of Pre-school Children in Relation to Family Size and Adult Units

Adult 1-4-Member Family 5-7-Member Family <=8-Member Family
Units* A B C D A B C D A B C D
1 586 21 124 234                
2 959 36 91 179 682 28 106 235        
3         - - - - 808 30 114 242
4         758 30 110 216 930 34 129 259

* Total calorie need of a household divided by the calorie need of an adult male (20-39 years)
A = calorie intake per person per day (child)
B = protein intake per person per day (child)
C = calorie adequacy ratio, according to method B (see second footnote to table 1)
D = protein adequacy ratio, according to method B
- = not computed in view of few (<= 3) households in this category

Children appear to satisfy their protein requirements whether assessed by method A or B. However, for many children this may be unrealistic. Inadequate energy intake reduces the utilization of protein in the diet, and frequent infection imposes an added requirement for protein for catch-up during the recovery phase (4).

The data do not support the "son preference" hypothesis in the intra-familial distribution of food when adjustment is made for differential nutrient needs of boys and girls.

Among the factors affecting nutrient intake and nutrient adequacy of pre-school children which have far-reaching policy implications are: per capita expenditure on food, timing of the introduction of solid food, spacing of children, and mother's education.

The net effect of per capita expenditure on food is significant and positively associated with nutrient intake and nutrient adequacy of pre-school children. This relationship holds true not only for pre-school children as a whole but also for the majority of children of other ages. These findings suggest that with improvement in a household's economic position the energy needs of children can be satisfied. This has also been verified by data in the present study that show that some children, particularly those from the poorest households, fail to meet their energy requirement even when this requirement is low (i.e., when the need is assessed by method B); but with improvement of income and land-holding status, children, or at least infants, can satisfy their energy needs even when this need is estimated to be high (i.e., assessed by method A)-see table 2.

The results obtained from regression analysis also show a strong inverse relationship between the timing of introduction of solid food and nutrient intake and the nutrient adequacy ratio. In other words, the longer the delay in introducing solid food, the worse the effect on nutrient intake and nutrient adequacy ratios. These findings reinforce the need for designing nutrition education programmes that emphasize the timely introduction of solid food along with breast-milk to ensure caloric adequacy for infants. The results of the present study suggest that interventions capable of inducing families to start feeding their babies solid food could yield significant improvement in meeting the calorie needs of infants This also depends on the economic condition of the household, apart from the need for nutrition education.

The findings of an insignificant but consistently inverse relationship between spacing (i.e. number of children in the age group 0-6 years) and nutrient intake and nutrient adequacy for pre-school children as a whole and for children of any age suggest that proper birth-spacing and limiting the number of children will ensure better nutrient intake and nutrient adequacy for pre-school children.

The consistently significant and positive association between mother's education and nutrient intake of infants (<=1 year) also suggests that improvement of mother's education may be an important input for the nutritional wellbeing of the youngest children, who bear the highest burden of childhood deaths in rural Bangladesh.

These findings, though obtained from a single village in rural Bangladesh, clearly point to the need to augment household income, introduce solid food along with breast-milk at the right time, space and limit number of children, and enhance the mother's educational level to ensure sufficient nutrient intake and nutritional adequacy for pre-school children.

APPENDIX. Operational Definitions of Independent Variables Used in Regression Model (Tables 4 to 6)

Per Capita Expenditure on Food

Expenditure on food was measured using information on the market price of each of the food items consumed per day by each member of the household. Information on market price per unit of a food item was multiplied by total quantity of corresponding food item consumed, and this was summed for all food items for each member of the household to arrive at the total expenditure on food at the household level. This was divided by total family size of a household to calculate per capita expenditure on food. This is expressed in take per person per day, which was found to be Tk 4.06.

Education
Education was measured in terms of number of years of schooling. The determining question was, "What is the highest grade of education you have completed?" This was coded as follows: 0 = no formal education; 1 = grades 1-5; 2 = grades 6-9; 3 = grade 10 and above. The mean education scores for father and mother were 0.68 and 0.25 respectively.

Age
Information on age of children was obtained from mothers in exact months and years. The determining question was, "What is the age of your child (children)? Give exact age in years and months." This was scored as follows: 1 = 0-11 months; 2 = 1-3 years; 3 = 3-4 years. The numbers of children in each age category were 13, 34, and 52 respectively. Age dummies were introduced into the regression model to measure any trends in nutrient adequacy in a child's early years.

Sex
The effect of sex on nutrient intake was measured by introducing sex dummies in the regression model. There were 54 male and 45 female pre-school children (0-4 years).

Age of Infant at Introduction of Solid Food
Mothers were asked to state the exact age of the infant when solid food was introduced. The determining question was, "At what age did you introduce solid food to your child? Give exact age." The average age of the child in this study was a little over six months.

Family Size
"Family" includes those members of the household who normally eat from the same kitchen. The determining question was, "What is the size of your family-i.e. those who normally (almost every day) eat from your kitchen?" Information on family size was obtained from the head of the household. The average family size in this study was 5.45.

ACKNOWLEDGEMENTS

The findings presented here are part of a major study on "Determinants of Intra-familial Distribution of Food and Nutrient Intake in Rural Bangladesh." The financial supported from UNICEF to analyse the data of the present study is gratefully acknowledged. The author is also grateful to Dr. Nevin S. Scrimshaw, Institute Professor at MIT, Professor Richard Jolly and Dr. Hossein Ghassemi of UNICEF, and Professor Paul Streeten of Boston University for intellectual and moral support. Dr. Scrimshaw deserves special thanks for his valuable comments on an earlier version of this paper. The author is solely responsible for any errors remaining.

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