IYCF Evidence

Dear Dr. Connolly:

You ask a very pertinent question. There is a growing body of literature, much of it with conflicting results, on the association between the WHO/UNICEF IYCF indicators and various types of malnutrition. Just search PubMed for IYCF indicators and stunting to find such publications. Several of these studies, mostly cross-sectional surveys, show a lack of association. I have personally assisted in several surveys which fail to demonstrate an association, and I have analyzed DHS datasets from Ethiopia and Guinea which showed that IYCF indicators are much more weakly related to stunting and wasting than many other variables, such as measures of socio-economic status or environmental sanitation and hygiene.

The reasons for this apparent lack of association are poorly understood. I don't think these studies prove that dietary diversity, exclusive breastfeeding, or the other IYCF indicators are truly unrelated to nutritional status in children 6-23 months of age; however, this possibility must be investigated. We cannot accept a hypothesis just because UN agencies say so or advocates believe it to be true. I suspect that the standard indicators are insufficiently precise and/or sensitive to be able to demonstrate an association in cross-sectional surveys, especially when the data are collected by overworked interviewers during a long interviews with tired respondents. Moreover, a cross-sectional survey collecting data from interviews, even if data collection is optimal, is a poor methodology to investigate associations between variables.

So, in short, you should not be too surprised at the lack of association in your report. Now we just need to find the funding and develop appropriate study designs to investigate this further.