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Use of commercial infant cereals as complementary food in infants and young children in Ghana

  • Abdul-Razak Abizari1Email author,
  • Zakari Ali1,
  • Collins Nana Essah1,
  • Patience Agyeiwaa1 and
  • Margaret Amaniampong1
BMC NutritionBMC series – open, inclusive and trusted20173:72

https://doi.org/10.1186/s40795-017-0191-x

Received: 28 March 2017

Accepted: 16 August 2017

Published: 31 August 2017

Abstract

Background

Typical complementary foods in developing countries are often inadequate in multiple micronutrients. One way of preventing micronutrient deficiency among infants and young children (IYC) is to feed them a variety of nutrient dense foods. The use of commercial infant cereals (CIC) as complementary food is increasing in Ghana. However, it is unknown whether giving CIC may discourage inclusion of other locally available and nutritious foods as mothers may hold the notion that CIC is superior. This study therefore examined the use of CIC as complementary food, the micronutrient intake from CIC and reasons for its use.

Methods

A cross-sectional study was conducted involving mothers with IYC aged 6-23 months who give CIC as complementary food. Questionnaires were administered to estimate the usual daily frequencies and quantities of CIC. Micronutrient intakes from CIC were calculated. We also calculated the proportion of the recommended nutrient intake (RNI) contributed by micronutrients from CIC.

Results

Of the 384 children sampled, 64.6% were aged 13-23 months and 50.3% were females. More than half of the mothers earned income through trading (55.2%) and nearly one quarter of them had senior high school education (24.7%). Majority of the children consumed 3–4 tablespoons (52.3%) of CIC in a feeding moment. Younger children (6–12 months) were served CIC more frequent than older children (13–23 months). The mean ± SD of micronutrients from CIC were 6.76 ± 2.67 mg, 4.79 ± 1.70 mg, 384.12 ± 139.69 mg, 266.70 ± 100.74 mg and 69.11 ± 24.65 μg for the minerals Fe, Zn, Ca, P and I respectively. The vitamin intakes were: 337.17 ± 119.70 μg, 42.88 ± 15.28 mg, 0.84 ± 0.31 μg, 34.24 ± 12.22 μg and 2.70 ± 1.03 mg for vitamin A, vitamin C, vitamin B12, folic acid and niacin respectively. Micronutrients from CIC consumption contributed to at least 70% of the RNIs for Fe, Zn, Ca, I, vitamin A, vitamin C and vitamin B12. Mothers believed that CIC alone could meet the nutritional needs of children and ensure optimal growth and health.

Conclusion

The results of present study show that use of CIC as complementary food was high among mothers with IYC 6–12 months. Mothers believed that CIC was nutritionally adequate for their children and did not see the need to include or enrich other locally available complementary foods. Mothers should be educated on the need to include other foods with CIC to increase the dietary quality of IYC.

Keywords

Commercial infant cereals Micronutrients Young children Ghana

Background

Adequate nutrition during infancy and early childhood is fundamental to the development of a child’s full potential [1]. Micronutrient deficiency is of public health concern in developing and developed countries and affects about 2 billion people [2]. Given the increased nutrient demands of young children, they are one of the population groups most vulnerable to micronutrient deficiencies [3]. Childhood deficiency in zinc and vitamin A is linked to child deaths [4]. The combined effect of iodine deficiency and stunted growth also affect a child’s development potential [4].

Breast milk alone can totally satisfy the nutritional requirements of infants within the first 6 months after birth [5]. After this period, breast milk becomes inadequate for optimal growth and development and complementary foods are introduced to increase energy and nutrient intake [6]. Breastfeeding is recommended to continue along with complementary feeding until a child’s second birthday or beyond [6]. Complementary feeding is important, considering the rapid mental and physical developments that take place in this age group which occur with a particularly high need for micronutrient intake [7]. Foods for complementary feeding therefore need to be more nutrient-rich than the foods typically consumed by other age groups in the household [8]. Complementary foods are regarded transitional foods and usually include local and industrially processed foods [9] including CIC [10].

Typical complementary foods in developing countries are often inadequate in multiple micronutrients especially iron and zinc [8, 11, 12]. To ensure adequate nutrition in these children, the World Health Organization recommends age appropriate complementary feeding that meets both frequency and diversity [6, 13]. It is recommended that IYC consume from at least four out of seven core food groups in a day to ensure adequate nutrient intake [13]. Dietary diversity is shown to be associated with adequate micronutrient intake in different developing country settings [14, 15]. Even though CIC are fortified with some micronutrients [16], mostly iron [17], calcium, zinc, phosphorus, thiamine, riboflavin and niacin [18] which are key to the growth and development of IYC, consumption these foods alone may not meet daily recommended needs of IYC [19].

CICs are increasingly becoming popular as complementary food in Ghana, especially among urban mothers [20, 21]. As mothers may hold the notion that CIC are superior to local complementary foods, CIC use may discourage inclusion of other locally available and nutritious foods and reducing dietary diversity of IYC. CIC usage and consumption levels among IYC, the reasons mothers may prefer feeding their IYC with CIC instead of using locally available, nutritious and relatively cheap alternatives are unknown. This study therefore examined the use of CIC as complementary food, the consumption levels among IYC, the micronutrient content of commonly used CIC and reasons mothers may prefer CIC to enriching local complementary foods.

Methods

Study area

This study was conducted in Tamale, the administrative capital of the Northern region of Ghana. Tamale is one of the largest cities in Ghana and a metropolitan with an estimated land size of 646.9 sq. km located in the central part of the Region [22]. The total population size of the metropolis is estimated at 233,252 which is about 9.4% of the region’s population. The population is largely urban (80.8%) with a few living in rural localities (19.1%) of the metropolis. Women of reproductive age (15–49 years) in the metropolis make up about 23.8% of the population and children aged 0–4 years are 14% of the total population. The General Fertility Rate is 79.9 births per 1000 women aged 15–49 years. There are four major markets in the Metropolis namely: Central Market, Aboabo, Kukuo and Lamashegu. In addition to these, there are satellite markets in large suburbs of the Metropolis. The Central market comprises of mini shops and stalls. There are also supermarkets in the city where commercial infant cereals are purchased [23].

Design, target population and sampling

A descriptive cross sectional study design was used in the present study. The target population was mothers with infants and young children 6–23 months in Tamale Metropolis. This study included only mothers who had children 6–23 months and used commercial infant cereal as part of complementary foods given to the child.

Using an alpha of 1.96 at 95% confidence interval with a permitted 5% margin of error and an assumed 50% prevalence of micronutrient adequacy from commercial infant cereals in the Northern region, the required sample size was 384. Data were collected mainly from five urban suburbs (Aboabo, Lamashegu, Vitting, Sakasaka, and Nyohini) within the Tamale metropolis through visits to selected households. Mothers using CIC as complementary food in selected communities were first identified at child welfare clinics and followed home to complete informed consent and research questionnaire. Recruitment at child welfare clinics continued until the required sample size was met.

Data collection tools and procedures

Semi structured questionnaires were used for data collection. Questionnaire administration was done through face-to-face interviews in the language the respondent understood. The questionnaire elicited information about maternal and child demographic characteristics, use of commercial infant cereal, preferred brand of infant cereal, number of times CIC is served in a day, and quantity of CIC fed to child in a feeding moment.

Estimation of quantity of infant cereal consumed in a day

The number of times CIC was consumed during the preceding 24 h and the estimated number of tablespoons of CIC consumed by children per feeding moment were determined by recall. For mothers who gave sachets (50 g) of CIC, their equivalents in household tablespoons were estimated. The total tablespoons of CIC consumed in a day by children was calculated by multiplying the number of times CIC was consumed in a day by the average (usual) number of tablespoons of CIC consumed per feeding moment.

From a subgroup of 20 mothers, we estimated the quantity (in grams) of CIC equivalent to a typical tablespoon given by mothers. We used the two most preferred brands of CIC (Cerelac and Yumvita) for this estimation. Mothers were presented their preferred brand and asked to use their usual household tablespoon to fetch a usual tablespoonful of CIC for their infant or young child. Each mother or caregiver gave two scoops of a usual tablespoonful of CIC. Each scoop was weighed with an electronic scale (Citizen CY 360, precise to 20 mg) and an average of the two was taken as the estimated weight of the usual tablespoonful for each brand of CIC. The average weight of a typical tablespoonful of CIC offered to children was calculated from the averages of the two most preferred brands.

Estimation of daily micronutrient intake from CIC

Daily micronutrient intake of children from CIC was estimated by determining the micronutrient content of a typical tablespoon of the preferred brand of CIC and the total tablespoons consumed in a day. The micronutrient content of the preferred brand and flavour of CIC was listed per 100 g of the product by the manufacturer. The micronutrient content of a typical tablespoon of mother’s preferred brand and flavour of CIC was calculated by proportion. Vitamin A content of CIC was stated in international units (IU), these were converted to micrograms (μg) by multiplying by 0.3 [24]. The amount of micronutrients consumed in a day by IYC from CIC was calculated by multiplying the amount of micronutrient in a typical tablespoon of the preferred brand and flavour by the total tablespoons of CIC consumed in a day. We made the following assumptions for the estimation of daily micronutrient intake from CIC: (i) children completely consumed the quantity of CIC prepared for them per eating moment (ii) the micronutrient content of different brands (as listed by the CIC manufacturers) are reasonably stable. Probabilities of inadequacy of the micronutrients were not calculated as at least two days of repeated dietary recalls are required [24]. We calculated the proportion of the RNI contributed by micronutrients from CIC. We used RNIs provided by FAO/WHO [25] and assumed 12% and moderate bioavailability for iron and zinc respectively.

Data analysis

Data was entered, cleaned and analyzed using IBM SPSS (version 21). Continuous data were presented as means and standard deviations while categorical data were presented as frequencies and percentages.

Results

Socio-demographic characteristics of respondents

The mean ± SD age of mothers in this study was 28.7 ± 4.7 years and four in ten mothers were within the age range 25–29 years (40.1%). Two-thirds of the mothers/caregivers have attained at least junior high school education. Majority of the mothers were married (92.2%), practiced Islamic religion (75.3%), earned income through trading (55.2%) and were from the Dagomba ethnic group (58.1%). The average child in this study was a little above the first birthday (14.9 ± 4.8 months) with more than six in ten aged 13–23 months (64.6%). The proportion of female children in the sample was a little more than half (50.3%) (Table 1).
Table 1

Demographic characteristics of sample

Characteristics

Mean ± SD

Frequency

Percentage

Child characteristics

Sex

 Male

 

191

49.7

 Female

 

193

50.3

Mean age (months)

14.9 ± 4.8

  

Age group (months)

  

 6–12

 

136

35.4

 13–23

 

248

64.6

Maternal characteristics

Mean age of mothers (years)

28.7 ± 4.7

  

Age group of mothers (years)

  < 20

 

2

0.5

 20–24

 

65

16.9

 25–29

 

154

40.1

 30–34

 

118

30.7

 35–39

 

35

9.1

 40+

 

10

2.6

Education

 None

 

77

20.1

 Primary

 

50

13.0

 JHS

 

90

23.4

 SHS

 

95

24.7

 Tertiary

 

72

18.8

Marital status

 Married

 

354

92.2

 Currently unmarried

 

4

1.0

Religion

 Islam

 

289

75.3

 Christian

 

93

24.2

 Other

 

2

0.5

Ethnicity

 Dagomba

 

223

58.1

 Gonja

 

51

13.3

 Akan

 

50

13.0

 Other

 

60

15.6

Occupation

 Farmer

 

14

3.6

 Trader

 

212

55.2

 Civil servant

 

69

18.0

 Unemployed

 

38

9.9

 Other

 

51

13.3

Knowledge and opinion of respondents on commercial infant cereal utilization

Table 2 presents information on the knowledge and opinions of mothers on the use of CIC. The majority of the mothers had information about CIC from the media (radio and television advertisements) (50.3%) and knew at least two brands (57.0%) of CIC on the Ghanaian market. Although the majority of mothers knew more than one brand of CIC, more than nine in ten mothers purchased Cerelac brand (Nestle). Majority of mothers purchased CIC packaged in tin containers (79.9%) rather than single use packs. Forty-six percent of mothers held more than one reason for using CIC as complementary food for their children. Some of the specific reasons given for utilization of CIC include: CIC help in infant growth and development (29.7%), it provides sufficient nutrients for infants and young children (9.4%) and easy to prepare (4.2%).
Table 2

Knowledge on commercial infant cereal and maternal opinions on its use

Item

Frequency

Percentage

Source of information on CIC

 Media (radio and television)

193

50.3

 Health worker

122

31.8

 Friends

43

11.2

 Others

26

6.8

Brand(s) of CICs known

 Cerelac

157

40.9

 Motherluck

5

1.3

 Yumvita

3

0.8

 Two or more of the brands

219

57.0

Brand of CIC used for child

 Cerelac

350

91.1

 Motherluck

4

1.0

 Yumvita

30

7.8

Package of CIC used

 Tin (400 g)

307

79.9

 Sachet (50 g)

77

20.1

Mothers’ opinion on CIC as complementary food

 Helps in infants growth and development

114

29.7

 Provides sufficient nutrient for infants and young children

36

9.4

 Infants and young children prefer it to infant formula

20

5.2

 Easy to prepare

16

4.2

 It prevents diseases in infants and young children

8

2.1

 Two or more of the opinion

177

46.1

 Others

12

3.1

Duration of CIC use as complementary food

 At least 1 month

18

4.7

 2–6 months

127

33.1

 7–12 months

142

37.0

 More than 12 months

97

25.3

Daily intake of commercial infant cereal by infants and young children

Children ate between 1 and 5 tablespoons of CIC in a feeding moment. Overall, most of them ate 3–4 tablespoons (52.3%) of CIC in a feeding moment. The number of tablespoons of CIC consumed by children in a serving differed by age group. For instance, while the majority of children aged 6–12 months ate at least 2 tablespoons (80.9%), the majority of those aged 13–23 months ate 3–4 tablespoons (70.6%) in a feeding moment. In a day, children were served CIC between 1 and 3 times. A little above six in ten children were served two times (62.0%) of CIC in a day. Younger children (6–12 months) were served with CIC more frequent than older children (13–23 months); while the majority of children 6–12 months were served three times (55.9%) of CIC in the day, the children aged 13–23 months were served two times (73.8%) of CIC in the day. The estimated average weight of a usual tablespoon of CIC given to children was ~15.0 ± 0.5 g (Table 3).
Table 3

Daily intake of commercial infant cereal

Variable

Frequency (%)

Age groups (months)

6–12

13–23

All

n

136

248

384

Tablespoons per serving

 1–2

110 (80.9)

69 (27.8)

179 (46.6)

 3–4

26 (19.1)

175 (70.6)

179 (52.3)

  ≥ 5

0 (0.0)

4 (1.6)

4 (1.0)

Mean tablespoons ± SD

2.15 ± 0.54

2.95 ± 0.73

2.67 ± 0.77

Frequency CIC is served per day

 Once

5 (3.7)

29 (11.7)

34 (8.9)

 Two times

55 (40.4)

183 (73.8)

238 (62.0)

 Three times

76 (55.9)

36 (14.5)

112 (29.2)

Weight of tablespoon of CIC (g)

  

Mean ± SD

 n

  

20

 Cerelac

  

14.6 ± 3.0

 Yumvita

  

15.3 ± 3.4

 Both

  

15.0 ± 0.5

Micronutrient content and intake of commercial infant cereals

Table 4 presents the micronutrient content per 100 g of the most preferred brands and flavour, and per tablespoon of CIC consumed by children in this study. The micronutrient content of CIC (as stated by the manufacturer) varied greatly among different brands of CIC. For example, while the iron content of Yumvita was 12 mg per 100 g, the iron content of Cerelac and Motherluc were 7.5 mg per 100 g and 2.6 mg per 100 g respectively.
Table 4

Micronutrient content of infant cereals per 100 g and per tablespoon

Micronutrient

Brand of infant cereal

Cerelac (wheat)

Yumvita (wheat)

Motherluc wheat cereal

Content

Per 100 g

Per tablespoon

Per 100 g

Per tablespoon

Per 100 g

Per tablespoon

 Iron (mg)

7.5

1.125

12

1.80

2.6

0.39

 Zinc (mg)

5.5

0.825

6

0.90

ns

-

 Phosphorus (mg)

320

48.0

200

30.0

84

12.6

 Iodine (μg)

80

12.0

ns

-

ns

-

 Vitamin A (μg RAE)

390

58.50

390

58.5

ns

-

 Vitamin C (mg)

50

7.50

45

6.75

ns

-

 Vitamin B12 (μg)

1

0.15

0.6

0.09

ns

-

 Folic acid (μg)

40

6.00

35

5.25

ns

-

 Niacin (mg)

3

0.45

4.5

0.675

ns

-

1 tablespoon = 15.0 g

ns not stated

The mean ± SD of micronutrient intake from CIC were 6.76 ± 2.67 mg, 4.79 ± 1.70 mg, 384.12 ± 139.69 mg, 266.70 ± 100.74 mg and 69.11 ± 24.65 (μg) for the minerals; Iron, Zinc, Calcium, Phosphorus and Iodine respectively. The vitamin intakes were; vitamin A (337.17 ± 119.70 μg), vitamin C (42.88 ± 15.28 mg), vitamin B12 (0.84 ± 0.31 μg), folic acid (34.24 ± 12.22 μg) and niacin (2.70 ± 1.03 mg). Micronutrients from CIC consumption contributed to at least 70% of the RNIs for Iron, Zinc, Calcium, Iodine, vitamin A, vitamin C and vitamin B12 (Table 5).
Table 5

Estimated daily micronutrient intake from commercial infant cereals

Micronutrient

n

6–12 months

% RNI

13–23 months

% RNI

All

% RNI

Minerals (mean ± SD)

 Iron (mg)

384

6.44 ± 2.62

83.61

6.93 ± 2.68

114.43

6.76 ± 2.67

122.89

 Zinc (mg)

380

4.56 ± 1.68

111.12

4.92 ± 1.71

120.03

4.79 ± 1.70

116.84

 Calcium (mg)

384

368.48 ± 134.87

92.12

392.70 ± 141.80

78.54

384.12 ± 139.69

83.35

 Phosphorus (mg)

384

256.17 ± 96.80

na

272.47 ± 102.58

na

266.70 ± 100.74

na

 Iodine (μg)

350

65.40 ± 24.21

72.67

71.22 ± 24.71

79.13

69.11 ± 24.65

76.79

Vitamins (mean ± SD)

 Vitamin A (μg RAE)

380

320.89 ± 117.55

80.22

346.24 ± 120.17

86.56

337.17 ± 119.70

84.29

 Vitamin C (mg)

380

40.84 ± 14.96

136.14

44.02 ± 15.37

146.73

42.88 ± 15.28

142.94

 Vitamin B12 (μg)

380

0.80 ± 0.30

114.15

0.86 ± 0.32

95.35

0.84 ± 0.31

102.08

 Folic acid (μg)

380

32.61 ± 11.96

40.77

35.14 ± 12.30

23.43

34.24 ± 12.22

29.63

 Niacin mg

380

2.56 ± 1.01

63.96

2.77 ± 1.03

46.26

2.70 ± 1.03

52.60

na RNI not available for this nutrient

Discussion

This study sought to determine the use of CIC as complementary food, the consumption levels among different age groups of IYC, the micronutrient content of commonly used CIC and reasons mothers prefer CIC to enriching local complementary foods. The main findings were that CIC use among mothers was high, younger children 6–12 months were more likely to depend entirely on CIC as complementary food but not those aged 13–23 months and mothers held various reasons and opinions (including; believing that CIC help in infant growth and development, provides sufficient nutrients for their children and easy to prepare) for depending on CIC as complementary food for their children instead of giving a diversified diet made of locally available and nutritious foods.

The high use of CIC as complementary food among mothers in this study is consistent with the findings of a study in urban Ghana among mothers giving complementary foods [20]. A recent survey of the market revealed a wide range of different CIC brands on the Ghanaian market [21], probably driven by a high demand. Mothers in this study believed that the use of CIC was good for child growth and development and was enough to meet the nutritional needs of their IYC. This is probably the reason for the high demand of CIC by mothers. With this notion that CIC could meet the nutritional needs of their children and promote growth, mothers may not see the need to include locally available and nutrient dense complementary foods which would improve dietary diversity and meet nutritional needs. Contrary to our findings, an earlier study reported convenience as a major influence for the use of CIC with health benefits as second.

The majority of mothers used Cerelac (Nestle Ghana limited) as their preferred brand of CIC for complementary feeding. The dominance of Cerelac as a preferred CIC in present study is consistent with earlier studies in Ghana [20, 21]. The wide use of this brand could be due to the variety of flavours it presents (maize, wheat, rice, millet, yummy fruits and fruits) and the longer years it has been on the Ghanaian market as well as a strong media marketing. With Cerelac, mothers can easily vary the flavours from time to time to suit child’s preference or provide variety, however, the most preferred flavour was wheat flavour. The other available brands did not have as many flavours. For instance, Yumvita (Promasidor Ghana limited) had only two flavours (wheat and maize & wheat) and Motherluc (Atona foods investments Ghana) was available as only wheat flavour. As mothers change these flavours, it might appear to them as though they are diversifying the diet for their children, but it is the same cereal based foods eaten on different days, usually as child becomes fed up with one flavour. This does not increase the diet diversity of children.

Children were served CIC between one and three times in a day. Similar frequency of infant cereal consumption has been reported among Ghanaian children [20]. Our data further reveals that younger children were fed CIC more frequent than older children. For younger children, high frequency of feeding CIC may mean fewer eating moments to offer other foods from the household. This makes these children almost entirely dependent on CIC for nutrients apart from breastmilk especially because mothers believe that CIC alone could satisfy the nutritional needs of their children. The lower frequency of feeding CIC among older children may be explained by the introduction and continuing feeding of household food. Further, it may be relatively more expensive to feed older children CIC more frequently because the quantity of intake may increase.

To meet micronutrient requirements of children taking complementary foods, fortified foods have been suggested to be included [26] and data from studies in different developing country settings have emphasized the importance of fortified foods in meeting micronutrient needs. For example, a study in Indonesia found that without inclusion of fortified foods (including infant cereal), it was unlikely for children especially those from low socioeconomic households to have adequate intakes of iron, zinc, niacin and thiamin [27]. Another study in rural Kenya has shown that dietary adequacy of iron, zinc and calcium are unlikely to be met by consumption of only local complementary foods and suggests fortified foods to ensure their adequacy [28]. Results from a study among South African children also show higher intake of iron, zinc, vitamin A, vitamin C, vitamin B6, vitamin B12 and niacin from complementary foods including CIC [29]. It is important to note that, CIC in these studies was given with other local complementary foods and therefore diet diversity was likely to be high and CIC added to the micronutrients from other foods consumed. For children to meet adequate intakes especially among the younger children who were less likely to consume other foods, mothers should be encouraged to include locally available and nutrient dense complementary foods to increase the dietary diversity and meet nutritional needs of IYC.

Cereals contain phytate [30] and polyphenols [31] which reduce the bioavailability of some micronutrients contained in them especially iron and zinc [32, 33]. Overcoming low bioavailability of iron in cereal based complementary foods is perhaps one of the greatest challenges with fortification of infant foods [34].The type of cereal grain used in preparation has little effect on iron bioavailability [35] and dephytinization studies have reported mixed findings [36, 37]. In spite of these, inclusion of enhancers of iron absorption such as ascorbic acid (vitamin C) has been successful in improving iron bioavailability from infant cereals [32, 3840]. Estimated iron intake from CIC in present study is therefore likely to be absorbed as intake levels of vitamin C from CIC was appreciably high.

The interpretation of the findings in this study need to be made while keeping some limitations in mind. First, we assumed that children ate all portions that were prepared for them at each eating moment, but may not always be the case. There may be leftovers but our estimations of consumption and subsequent calculations did not account for that. If there were many instances of leftover then our estimations of micronutrient intake could be overestimated. We however believe that over time caregivers are able to serve quantities that do not always result in leftovers.

Secondly, we used the nutrient values specified by CIC manufacturers which may not always be entirely correct. Variations between manufacturers’ specified values on products and results of independent analyses of product samples have been reported [41, 42]. If the micronutrient contents specified by infant cereal manufacturers were over reported, our estimations of intake could also be overestimated. However, micronutrient content variations between manufacturers’ values and analyzed values are not always adverse. For instance, there were no adverse variations in the iodine content of different brands of bouillon cubes in Ghanaian markets between manufacturer values and analyzed values [43]. Moreover, manufacturer nutrient information could be used to build food composition databases [44], suggesting that they could be relied upon for nutrient assessment of foods.

Further studies are warranted to compare micronutrient adequacy of children who consume CIC and those who rely only on family foods and explore the effect of CIC use on recommended infant feeding indicators as present study did not include IYC who receive only family foods.

In spite of these limitations, our results have shed ample light on the use and consumption levels of CIC as complementary food among different age groups of children in Ghana.

Conclusion

The results of present study show that use of CIC as complementary food was high among mothers with IYC 6–12 months. Mothers believed that CIC was nutritionally adequate for their children and did not see the need to include or enrich other locally available complementary foods. Mothers who offer CIC should be educated on the need to include other locally available and nutrient dense foods in the diets of IYC to ensure nutrient adequacy.

Abbreviations

CIC: 

Commercial infant cereal

IYC: 

Infants and young children

RNI: 

Recommended nutrient intake

WHO: 

World Health Organization

Declarations

Acknowledgements

The authors are grateful to the mothers and caregivers for their participation in the study.

Funding

There was no external funding received for this study.

Availability of data and materials

The data supporting the conclusions of this article are included within the manuscript. The dataset is available from the corresponding author on reasonable request.

Authors’ contributions

Conception and design of study: A-RA, CNE, PA and MA; data collection: CNE, PA and MA; Analysis and interpretation of data: A-RA, ZA, CNE, PA and MA; manuscript drafting: A-RA and ZA; primary responsibility for the final content: A-RA and ZA. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Participation in this study was voluntary and participants signed or thumb printed (where mother was illiterate) a statement of an informed consent before she was interviewed. Verbal consent was also obtained from household heads after necessary information was given. Moreover, the permission to carry out this study was sought from the Metropolitan directorate of health. The study protocol was approved by the Scientific Review Committee of the School of Allied Health Sciences, University for Development Studies, Ghana.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Authors’ Affiliations

(1)
Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies

References

  1. Pan American Health Organization: Guiding principles for complementary feeding of the breastfed child. 2003.Google Scholar
  2. Tulchinsky TH. Micronutrient deficiency conditions: global health issues. Public Health Rev. 2010;32(1):243.View ArticleGoogle Scholar
  3. Das JK, Salam RA, Kumar R, Bhutta ZA. Micronutrient fortification of food and its impact on woman and child health: a systematic review. Syst Rev. 2013;2(1):1.View ArticleGoogle Scholar
  4. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.View ArticlePubMedGoogle Scholar
  5. Kramer M, Kakuma R. Optimal duration of exclusive breastfeeding (review). Cochrane Database Syst Rev. 2002;1:11–2.Google Scholar
  6. WHO, UNICEF, USAID, AED, UCDAVIS, IFPRI. Indicators for assessing infant and young child feeding practices: part 1: definitions: conclusions of a consensus meeting held 6-8 November 2007 in Washington DC, USA. Geneva: WHO; 2008.Google Scholar
  7. Plessow R, Arora NK, Brunner B, Wieser S. Cost-effectiveness of price subsidies on fortified packaged infant cereals in reducing iron deficiency anemia in 6-23-month-old-children in urban India. PLoS One. 2016;11(4):e0152800.View ArticlePubMedPubMed CentralGoogle Scholar
  8. Dewey KG, Vitta BS. Strategies for ensuring adequate nutrient intake for infants and young children during the period of complementary feeding. Washington: Alive & Thrive; 2013.Google Scholar
  9. World Health Organization: Global strategy for infant and young child feeding. 2003.Google Scholar
  10. Lind T, Lönnerdal B, Persson L-Å, Stenlund H, Tennefors C, Hernell O. Effects of weaning cereals with different phytate contents on hemoglobin, iron stores, and serum zinc: a randomized intervention in infants from 6 to 12 mo of age. Am J Clin Nutr. 2003;78(1):168–75.PubMedGoogle Scholar
  11. Dewey KG. The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: an evolutionary perspective. J Nutr. 2013;143(12):2050–4.View ArticlePubMedPubMed CentralGoogle Scholar
  12. Smuts CM, Lombard CJ, Benadé AS, Dhansay MA, Berger J, de Romaña GL, Untoro J, Karyadi E, Erhardt J, Gross R. Efficacy of a foodlet-based multiple micronutrient supplement for preventing growth faltering, anemia, and micronutrient deficiency of infants: the four country IRIS trial pooled data analysis. J Nutr. 2005;135(3):631S–8S.PubMedGoogle Scholar
  13. WHO U, USAID, AED, UCDAVIS, IFPRI. Indicators for assessing infant and young child feeding practices, part 2: measurement. Geneva: WHO; 2010.Google Scholar
  14. Kennedy GL, Pedro MR, Seghieri C, Nantel G, Brouwer I. Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children. J Nutr. 2007;137(2):472–7.PubMedGoogle Scholar
  15. Moursi MM, Arimond M, Dewey KG, Trèche S, Ruel MT, Delpeuch F. Dietary diversity is a good predictor of the micronutrient density of the diet of 6-to 23-month-old children in Madagascar. J Nutr. 2008;138(12):2448–53.View ArticlePubMedGoogle Scholar
  16. Ayivor J, Debrah S, Forson A, Nuviadenu C, Buah Kwofie A, Denutsui D. Trace elements in some imported commercial infant cereal formulas on the Ghanaian market by INAA. Der Pharma Chemica. 2011;3(5):94–100.Google Scholar
  17. Davidsson L, Kastenmayer P, Szajewska H, Hurrell RF, Barclay D. Iron bioavailability in infants from an infant cereal fortified with ferric pyrophosphate or ferrous fumarate. Am J Clin Nutr. 2000;71(6):1597–602.PubMedGoogle Scholar
  18. Lutter CK. Macrolevel approaches to improve the availability of complementary foods. Food Nutr Bull. 2003;24(1):83–103.View ArticlePubMedGoogle Scholar
  19. Gibbs M, Bailey KB, Lander RD, Fahmida U, Perlas L, Hess SY, Loechl CU, Winichagoon P, Gibson RS. The adequacy of micronutrient concentrations in manufactured complementary foods from low-income countries. J Food Compos Anal. 2011;24(3):418–26.View ArticleGoogle Scholar
  20. Pelto GH, Armar-Klemesu M. Balancing nurturance, cost and time: complementary feeding in Accra, Ghana. Matern Child Nutr. 2011;7(s3):66–81.View ArticlePubMedGoogle Scholar
  21. Masters WA, Kuwornu J, Sarpong D: Improving child nutrition through quality certification of infant foods: scoping study from a randomized trial in Ghana. 2011.Google Scholar
  22. Ghana Statistical Service. 2010 population and housing census summary report of final results. Accra: Ghana Statistical Service; 2012.Google Scholar
  23. Ghana Statistical Service. 2010 population and housing census Distric analytical report tamale metropolis. Accra: Ghana Statistical Service; 2014.Google Scholar
  24. Institute of Medicine. Dietary reference intakes: the essential guide to nutrient requirements. Washington, DC: The National Academies Press; 2006.Google Scholar
  25. Joint FAO WHO: Vitamin and mineral requirements in human nutrition. 2005.Google Scholar
  26. WHO/UNICEF. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: Who; 1998. p. 230.Google Scholar
  27. Fahmida U, Santika O. Development of complementary feeding recommendations for 12-23-month-old children from low and middle socio-economic status in west java, Indonesia: contribution of fortified foods towards meeting the nutrient requirement. Br J Nutr. 2016;116(Suppl 1):S8–s15.View ArticlePubMedGoogle Scholar
  28. Ferguson E, Chege P, Kimiywe J, Wiesmann D, Hotz C. Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children. Matern Child Nutr. 2015;11(Suppl Suppl 3):6–20.View ArticlePubMedGoogle Scholar
  29. Faber M. Complementary foods consumed by 6–12-month-old rural infants in South Africa are inadequate in micronutrients. Public Health Nutr. 2005;8(04):373–81.View ArticlePubMedGoogle Scholar
  30. Reddy N, Sathe S, Salunkhe D. Phytates in legumes and cereals. Adv Food Res. 1982;28:1–92.View ArticlePubMedGoogle Scholar
  31. Lachman J, Hosnedl V, Pivec V, Orsák M. Polyphenols in cereals and their positive and negative role in human and animal nutrition. In: Cereals for human health and preventive nutrition, Brno. Czech Republic: Mendelova Zemedelska a Lesnicka Univerzita; 1998.Google Scholar
  32. Hallberg L, Brune M, Rossander L. Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate. Am J Clin Nutr. 1989;49(1):140–4.PubMedGoogle Scholar
  33. Gibson RS, Bailey KB, Gibbs M, Ferguson EL. A review of phytate, iron, zinc, and calcium concentrations in plant-based complementary foods used in low-income countries and implications for bioavailability. Food Nutr Bull. 2010;31(2_suppl2):S134–46.View ArticlePubMedGoogle Scholar
  34. Hurrell RF. Fortification: overcoming technical and practical barriers. J Nutr. 2002;132(4):806S–12S.PubMedGoogle Scholar
  35. Cook JD, Reddy M, Burri J, Juillerat MA, Hurrell RF. The influence of different cereal grains on iron absorption from infant cereal foods. Am J Clin Nutr. 1997;65(4):964–9.PubMedGoogle Scholar
  36. Davidsson L, Galan P, Cherouvrier F, Kastenmayer P, Juillerat M-A, Hercberg S, Hurrell RF. Bioavailability in infants of iron from infant cereals: effect of dephytinization. Am J Clin Nutr. 1997;65(4):916–20.PubMedGoogle Scholar
  37. Hurrell RF, Reddy MB, Juillerat M-A, Cook JD. Degradation of phytic acid in cereal porridges improves iron absorption by human subjects. Am J Clin Nutr. 2003;77(5):1213–9.PubMedGoogle Scholar
  38. Davidsson L. Approaches to improve iron bioavailability from complementary foods. J Nutr. 2003;133(5):1560S–2S.PubMedGoogle Scholar
  39. Fairweather-Tait S, Fox T, Wharf SG, Eagles J. The bioavailability of iron in different weaning foods and the enhancing effect of a fruit drink containing ascorbic acid. Pediatr Res. 1995;37(4):389–94.View ArticlePubMedGoogle Scholar
  40. Derman D, Bothwell T, MacPhail A, Torrance J, Bezwoda W, Charlton R, Mayet F. Importance of ascorbic acid in the absorption of iron from infant foods. Eur J Haematol. 1981;25(3):193–201.Google Scholar
  41. Lobanco CM, Vedovato GM, Cano CB, Bastos DHM. Reliability of food labels from products marketed in the city of Sao Paulo, southeastern Brazil. Rev Saude Publica. 2009;43(3):499–505.View ArticlePubMedGoogle Scholar
  42. Fitzpatrick L, Arcand J, L’Abbe M, Deng M, Duhaney T, Campbell N. Accuracy of Canadian food labels for sodium content of food. Nutr. 2014;6(8):3326–35.Google Scholar
  43. Abizari A-R, Dold S, Kupka R, Zimmermann MB. More than two-thirds of dietary iodine in children in northern Ghana is obtained from bouillon cubes containing iodized salt. Public health Nutr. 2017;20(6):1107-13.Google Scholar
  44. Schakel SF, Buzzard IM, Gebhardt SE. Procedures for estimating nutrient values for food composition databases. J Food Compos Anal. 1997;10(2):102–14.View ArticleGoogle Scholar

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