Inappropriate Complementary Feeding Practices Research Articles

Maternal Feeding Practices of Children One to Three Years in Collins Chabane Municipality of South Africa

ABSTRACT The aim was to assess maternal feeding practices of children one to three years. A descriptive observational design was employed. The sample consisted of mothers-child dyads. A validated structured questionnaire was used. Data was analyzed using SPSS version 26.0. The nutrition status of the children at birth indicated 11.6% underweight as compared to the time of the study (7.2%), 7.9% were stunted increased to 38.0%, while wasting decreased from 11.4%–2.4%. Early cessation of breastfeeding and inappropriate complementary feeding practices were the factors influencing growth. The prevalence of underweight and wasting were low while stunting and overweight were high.

Study of Factors Associated with Inappropriate Complementary Feeding Among Children Aged 6 to 23 Months, Western Health Region of the Gambia, 2020

Introduction: Inappropriate complementary feeding practices are a major cause of morbidity and mortality in the first two years of life. The aim was to investigate factors associated with inappropriate complementary feeding practices among mothers of children aged 6-23 months in the Western Health Region of The Gambia. Methodology: This was a cross-sectional, descriptive and analytical study conducted from 14 September to 14 October 2020. The study population consisted of mothers of children aged 6 to 23 months attending reproductive and child health clinics and enrolled in the "Every Child Counts - My Child Project" immunization and vaccination program. Simple random sampling was used to select participants using the project. Data were collected by means of a questionnaire administered by telephone interview and concerned the socio-demographic characteristics of the mothers, the professional and economic characteristics of the parents, the socio-demographic characteristics of the children, diet and complementary feeding practices. Results: The mean age of the mothers was 28.3 (±5.4) years and that of the children 14.2 (±4.8) months. Minimum dietary diversity was 33.3%, minimum meal frequency 88% and minimum acceptable dietary intake 14.5% for all children aged 6-23 months. Non-respect of minimum dietary diversity was associated with the child's female sex, with an OR = 16.3 [1.83-145.7], with the occurrence of both diarrhea and Acute Respiratory Infection (ARI) in the two weeks preceding the survey, with an OR = 27.2 [4.26-39.8], and with the child's birth in a public health facility, with an OR = 55.1 [1.53-197.7]. Children whose mothers were aged between 25 and 34 and whose fathers did not work had a higher risk of non-respect of the dietary diversity, with OR = 54.1 [2.4 6- 118.5] and OR = 22.5 [2.32 - 31.9] respectively. The factors associated with non-respect of the minimum meal frequency were the advanced age of the children: 12 to 17 months with an OR= 28.6 [1.65 - 49.5] and 18 to 23 months with an OR= 18.9 [1.67 - 215.0] and a history of both ARI and diarrhea with an OR=. 52,9 [1,61 - 173,7]. Non-respect of the minimum acceptable dietary intake was associated with older children aged 18 to 23 months OR= 14.4 [2.25- 93.0] and those whose mothers had vocational training OR=.24.2 [1.27- 46.3]. Conclusion: Complementary feeding practices are not very satisfactory. It is important to strengthen nutrition education in order to improve infant and young child feeding practices.

Appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months in Bhimphedi rural municipality of Nepal.

Appropriate complementary feeding plays a crucial role in the enhancement of child survival; and promotes healthy growth and development. Evidence has shown that appropriate complementary feeding is effective in preventing malnutrition and child mortality. Thus, the main objective of this study is to assess the prevalence of appropriate complementary feeding practice and associated factors among mothers of children aged 6-23 months. A community-based cross-sectional study was conducted from August to December 2018. A total of 259 mothers who had children aged 6-23 months were selected randomly from the 714 eligible mothers. A structured questionnaire was used to collect the data from the respondents. The data were collected in a tablet phone-based questionnaire using the Open Data Kit mobile application by face-to-face interview. Data analysis was done in SPSS version 21. Multivariable logistic regression was used to identify the factor associated with appropriate complementary feeding practice. The prevalence of appropriate complementary feeding practice was 25%. Mother and father with formal education (AOR 6.1, CI: 1.7-22.4 and AOR 5.6 CI: 1.5-21.2 respectively), counseling on IYCF (AOR 4.2, CI: 1.5-12.3), having kitchen garden (AOR 2.4, CI: 1.1-5.2) and food secured family (AOR 3.0, CI: 1.0-8.9) had higher odds of appropriate complementary feeding practice. This study revealed that a significant proportion of mothers had inappropriate complementary feeding practice for their children aged 6-23 months. This study highlights the need for behavior change communication and promotion of kitchen garden to address the associated factors and promote appropriate complementary feeding practice.

Probability of Inappropriate Complementary Feeding Practices on Children Aged 6-23 Months in Indonesia: Results of Indonesian Demographic Health Survey in 2017

Background: One of the causes of the double burden of nutrition problems in Indonesia is the early feeding of complementary feeding. The practice of providing complementary feeding in several countries, including Indonesia, has not reached the target and it is not yet known the magnitude of the probability of complementary feeding not following the recommendations in Indonesia based on national survey data. 
 Objective. To identify the risk factors for the failure of Infant and Young Child Feeding (IYCF) practice in urban and rural NTT.
 Objectives: This study aims to determine the Probability of inappropriate complementary feeding practices in Children aged 6-23 Months in Indonesia and the factors that influence it. 
 Methods: The research design uses cross-sectional studies. The data is sourced from the 2017 Indonesian Health Demographic Survey (IDHS) results. The sample was selected from women of childbearing age in IDHS 2017, namely women of childbearing age aged 15-49 years who had children aged 6-23 months who met the inclusion and exclusion criteria of 4,985 children. The data were analysed using multivariate logistic regression. 
 Results: The practice of giving complementary feeding according to recommendations in children aged 6-23 months in Indonesia is only 55.53%. Socio-economic status is very poor (p= 0.000; OR=1.785; 95% CI 1.44-2.213), rural residence (p= 0.000; OR=1.168; 95% CI 1.025-1.33), lower education (p= 0.002; OR=1.398; 95% CI 1.149-1.702), and grande multipara parity (p= 0.001; OR=1.57; 95% CI 1.238-1.992) is significantly associated with the practice of giving complementary feeding not by the recommendations.
 Conclusions: The probability of the practice of giving complementary feeding is not by the recommendation of 86% due to the socio-economic status of very poor families living in rural areas, low maternal education levels, and mothers with grande-multipara parity. It is necessary to improve the socio-economics of the family through the empowerment of mothers and families, increase access to health services in rural areas, improve maternal education through various programs, and intensify family planning programs to limit the number of children in the family.

Barriers to appropriate complementary feeding and the use of ultra-processed foods: A formative qualitative study from rural Oromia, Ethiopia.

Children's consumption of ultra-processed foods (UPF) is increasing in Ethiopia, but relatively little is known about the specific feeding practices that underlie this pattern. The objective of this study was to explore patterns of consumption of UPF by infants and young children within a broader context of inappropriate complementary feeding practices in extremely poor households in rural Oromia, Eastern Ethiopia. A formative qualitative study was conducted using semistructured interview questionnaires developed drawing on a socioecological model. A total of 16 focus group discussions with mothers (45 respondents), fathers (21 respondents)and grandmothers (23 respondents) of children aged 6-23 months in households that were beneficiaries of the Productive Safety Net Program were conducted, along with four key informant interviews with health workers. Qualitative transcripts were complemented with field notesbefore qualitative content analysis was applied. The key findings suggest that UPF were widely provided to infants and young children as part of a pattern of suboptimal complementary feeding, including both early and late initiation of complementary foods. In particular, UPF (including juice, biscuitsand lipid-based nutrient supplements) were diluted with or dissolved in water and fed to infants via bottle, often before the recommended age of initiation of 6 months. Mothers and caregivers reported that they perceived the products to be affordably priced and packaged, ready to use and convenient given their time constraints. The level of consumption of UPF and its effects on infant and young child feeding feeding practices and children's nutritional status in rural Ethiopia should be further explored.

Potential risk of stunting in children under five years living by the riverside: A systematic review

Introduction: Stunting, or linear growth failure, is defined by a height-for-age z-score of below -2SD according to WHO growth standard. Stunting can have short-, medium-, and long-term consequences. Rivers have an important role in human life. In several riverside areas, households still depend on the river for their livelihoods and health. This study aimed to explore the prevalence of stunting in children living by the riverside and its related factors. Methods: Epidemiological studies published from PUBMED, MEDLINE via EBSCOHost, Science Direct, ProQuest, and Research Gate databases were systematically searched. The publication period was not restricted. Only open-access and English articles were examined. Results: A total of 20 from 1200 studies were reviewed. The prevalence of stunting ranged from 20% to 48.3%. The other outcomes besides stunting were wasting and underweight status. There were 83 risk factors studied, and the most studied variables were age, gender, diarrhoea, water source, parent’s education, immunisation, and inappropriate complementary feeding practices (6 to 13 studies). Household water sources from rivers and economic status were consistently correlated with stunting. Majority of the risk factors studied were related to nutrition. From the environmental aspect, the most studied risk factors were water sources and sanitation. Conclusion: Children living by the riverside face a significant risk of stunting attributed to the consistent correlation between household water sources from rivers and economic status, affecting various aspects of daily life beyond drinking water. Future research is needed to examine the impact of environmental factors and the behaviours of riverside communities.

Determinants of inappropriate complementary feeding among children 6–23 months of age in Dessie City Northeast Ethiopia: a case-control study

BackgroundInappropriate complementary feeding is one of the leading causes of malnutrition among children 6–23 months old and delays children’s growth milestone. The determinants of inappropriate complementary feeding practice have diverse natures, so that many of the previous studies fail to generate adequate evidence on it. This study aim to address the determinants of in appropriate complementary feedings at community level.MethodsA community-based unmatched case-control study design was carried out among children 6–23 months of age in Dessie City from April 13, 2021 to May 13, 2021. Nine kebeles were selected by simple random sampling method. One month prior to the data collection time survey was conducted and 482 samples were taken from the preliminary survey data; 241 cases and 241 controls by computer generated random numbers. Interviewer administered questionnaire was used to investigate potential determinants of inappropriate complementary feeding practice. Binary logistics regression was used to identify independent determinants.ResultsPart working situation of mother [AOR = 0.21 CI: 0.08, 0.52] was negatively associated with inappropriate complementary feeding. Having no post-natal care visit [AOR = 4.062 CI:2.35,7.02], poor wealth status [AOR = 2.7 CI:1.09,6.68], food in-security [AOR = 4.49 CI:1.94,10.37], home delivery [AOR = 4.33 CI:1.43,13.15], having poor knowledge on infant and young child feeding [AOR = 5.94 CI:2.8,12.6], having no health education on complementary feeding [AOR = 2.54 CI:1.28,5.06] and father’s job [AOR = 2.2 CI:1.17,4.1] were found to be positively associated with inappropriate complementary feeding.ConclusionMothers’ work situation, fathers’ job, wealth index, food security, mothers’ knowledge on infant feeding, post-natal care, health education on infant feeding and place of delivery were independent determinants for inappropriate complementary feeding. Thus, interventions shall effectively address those factors to alleviate the problem.

Spatial variation and determinants of inappropriate complementary feeding practice and its effect on the undernutrition of infants and young children aged 6 to 23 months in Ethiopia by using the Ethiopian Mini-demographic and health survey, 2019: spatial and multilevel analysis.

Inappropriate complementary feeding practices (IACFPs) are major public health issues in Ethiopia, which usually result in stunting and becoming an intergenerational cycle. However, the spatial patterns and determinants of IACFP and its effect on undernutrition are not well understood in Ethiopia. Therefore, the aim of this study was to explore the spatial patterns and determinants of IACFPs and their effects on the undernutrition of infants and young children (IYC) in Ethiopia. This was a nationwide community-based survey study among 1,463 mothers of IYC aged 6-23 months in Ethiopia. The global spatial autocorrelation was assessed using the global Moran's-I to evaluate the spatial clustering of IACFPs. Significant clusters with high and low rates of IACFPs were explored. A multilevel mixed-effect logistic regression with cluster-level random effects was fitted to identify determinants of IACFPs with an AOR and 95% CI. The prevalence of IACFPs was 90.22%. The spatial pattern of IACFP in Ethiopia was clustered across regions (Global Moran's I = 0.63, Z-score = 12.77, value of p ≤0.001). Clusters with a high rate of IACFP were detected in southern, northwest, and eastern Ethiopia. Individual and community-level variables accounted for 63% of IACFP variation. Mothers with no education were 3.97 times (AOR = 3.97; 95% CI: 1.64-9.60) more likely to have IACFPs than those with higher education. The poorest HHs had 4.80 times the odds of having IACFPs as the richest HHs (AOR = 4.80, 95% CI: 1.23-18.71). The odds of having IACFPs were 2.18 times (AOR = 2.18; 95% CI: 1.28-3.72) higher among babies with no postnatal checkup. Non-breastfed IYC were 2.8 times (AOR = 2.80; 95% CI: 1.29-6.10) more likely to have IACFP when compared with breastfed ones. IYC with the inadequate introduction of solid, semi-solid, and soft foods, inadequate minimum dietary diversity, and inadequate minimum acceptable diet were more likely to have wasting, underweight, and stunting. This study showed the prevalence of IACFPs was very high, which had an effect on undernutrition and showed spatial variation in Ethiopia. Therefore, the government of Ethiopia and stakeholders should focus on women with no education and the poorest HHs, encourage PNC checkups, and encourage breastfeeding in the hotspot areas to minimize IACFPs in Ethiopia.

Determinants of Inappropriate Complementary Feeding Practice among 6 months-2 years old children attending Institute of Child and Mother Health (ICMH), Dhaka

Determinants of Inappropriate Complementary Feeding Practice among 6 months-2 years old children attending Institute of Child and Mother Health (ICMH), Dhaka

Empowering Cadres Through the Practice of Processing and Providing MP ASI in the Context of Stunting Prevention

Giving complementary feeding properly is not only to meet children's nutritional needs but also to stimulate children's eating skills. However, there are still many inappropriate complementary feeding practices, due to the lack of knowledge of mothers and the lack of available information. The cadres of Integrated Healthcare Centre (POSYANDU) as an extension of health workers are expected to be able to provide mothers with adequate information and skills regarding the proper practice of giving and processing complementary feeding. The purpose of this community service is to increase the knowledge of cadres regarding the practice of giving complementary feeding and the skills of cadres in processing the menu of complementary feeding. This community service involved 30 posyandu cadres in Rejosari Village. Activities carried out in the form of counseling accompanied by the practice of menu processing. Based on the results of the evaluation, the knowledge level of cadres has increased, which means that the cadres are considered to have understood and have been able to disseminate information related to proper complementary feeding practices and have been able to process the menu.

Influence of eating concept on eating behavior and stunting in Indonesian Madurese ethnic group

Background and objectivesStunting is a serious public health problem in Indonesia. Madura Island, which is inhabited by the Madurese ethnicity, had a very high stunting prevalence. The cultural factors of stunting mainly focus on food, food taboos, and early complementary feeding or prelacteal feeding practices. Therefore, this study aims to analyze the eating concept and its association with child feeding practices and stunting among the Madurese ethnic group in Indonesia.MethodsThis qualitative study was conducted in Sampang District, Madura Island, East Java, Indonesia. A total of 61 informants participated in this study (25 informants of in-depth interviews, 26 informants of FGDs, and 10 families in observations). Data collection consists of culture, values, and beliefs in child feeding practices that influence children’s nutritional status. The analysis used was content analysis by emphasizing the meanings, themes, and concepts of eating and stunting.Results and conclusionsStunting was considered a normal condition rather than a nutritional problem. The concept of eating is “eating rice.” Eating without other dishes is acceptable as long as there is rice on the plate. This concept affects inappropriate complementary food feeding practices and malnutrition among children under five. Overall, the study contributed to the improvement of the stunting reduction program by addressing how Madurese thought about eating and stunting.

Assessment of Complementary Feeding Practices and Nutritional Status of Children (0-24 months) in Akuku Toru Local Government Area of Rivers State, Nigeria

This study was carried out to assess complementary feeding practices of under-five children in Akuku Toru Local Government Area of Rivers State. A cross-sectional descriptive survey research was adopted for the study. The population for the study consisted of nursing mothers with children (0-24 months) attending their normal health services in seven (7) major primary health care centres in Akuku Toru Local Government Area, Rivers State. A sample size of 210 nursing mothers was selected for the study. The instrument used for data collection was a self-structured questionnaire titled “Assessment of Complementary Feeding Practices of Children Questionnaire”. The questionnaire was validated by three validates. Data generated using the research instrument was analyzed using frequency, percentages and mean. The findings obtained showed that most nursing mothers initiate complementary feeding at early age and their reasons often times are pressure from their family members who do not understand the benefits of adequate breast milk and pressure from employers to resume work. Majority of the sampled nursing mothers in the study area prefer cereal/grain, fruits, vegetables, yoghurt and custard over other complementary foods used in nursing a child. Majority of the respondent agreed that the nutritional status of infants introduced to complementary foods at their early stage of development is usually underweight, stunting and wasting. It was also established that inappropriate complementary feeding practices adopted by nursing mothers in the study areas has significant effect on the nutritional status of their infants. Therefore, the study recommends that there is need for promotion of women’s health and nutrition as a strategy that will benefit child nutritional status. Interventional programmes should target poorer household and mothers with lower educational level to improve complementary feeding practices of mothers. Developmental programmes should focus on empowering women in rural communities by improving of household income through creation of employment and access to credit facilities that will enable women engage in sustainable means of livelihood.

Complementary feeding pattern and its determinants among mothers in selected primary health centers in the urban metropolis of Ekiti State, Nigeria

The incidence of malnutrition in the first two years of life has been directly linked with inappropriate complementary feeding practices along with high infectious disease levels. This study was therefore aimed to assess the complementary feeding pattern among mothers of children aged zero to two years in selected health centres in Ado Ekiti, the capital of Ekiti State, Nigeria. The study was cross-sectional in design. One hundred and thirty-five mothers were selected from two health centres within Ado-Ekiti for this study. A semi-structured interviewer-administered questionnaire was used to collect information from the mothers. The questionnaire included questions that assessed the mothers’ socio-demographic characteristics and complementary feeding pattern. Most (62.5%) infants were introduced to complementary foods at 3–5 months old and water (43.3%) at 3 months of age. The main food item given to the infants on commencement of complementary feeding was formula food (45.9%) followed by fermented cereal gruel (37%). The timing of introduction for different food items revealed that in contrast to the use of fermented cereal gruel (23.8%), fewer children were introduced to iron-rich foods (15.1%) and fruits (11%) at 6 months to a year old. Mother’s knowledge of ideal age for the introduction of complementary feeding ({chi }^{2}= 20.547; p < 0.001) associated significantly with the age of introduction of complementary feeding. More than three-fifth (62.5%) of the respondents had commenced complementary feeding to their infants between 3 and 5 months while an excess of two-fifth (43.3%) of the respondents started giving their children water to drink at 3 months of age. Nurses and nutritionists in primary health care centers should take the lead role in educating mothers about the need for exclusive breastfeeding for the first 6 months of life and appropriate complementary feeding for ages 6–24 months.

Complementary feeding practices in children aged 6-23 months: An institution-based observational study

Background: Inappropriate complementary feeding practices in children may lead to adverse consequences ranging from growth failure to mortality. Intervention programs intending to optimize the practices should be based on identification of the lacunae and on the assessment of the magnitude of the problem. Aim: The aim of the study was to determine appropriateness and adequacy of complementary feeding given to children aged 6?23 months. Materials and Methods: Data regarding demographic profile, maternal education, source of information for feeding, and details of complementary feeding provided in the last 24 h were obtained from caregivers, using the standard WHO questionnaire. Chi-square test was used for determining the association between optimal feeding practices and continued breastfeeding, age-group, maternal education, and source of information. Results: The study enrolled 480 children (mean age: 12.9+5.1 month; male: female=1.22:1). 225 children (46.87%) had minimum meal frequency and 66 (13.8%) had minimum dietary diversity, 41 (11.08%) were receiving minimum acceptable diet. Only 103 mothers (21.5%) obtained the information regarding recommended complementary feeding practices from health professionals. There was a significant association between health professional being the source of information and presence of adequate dietary diversity (p&lt;0.01) and minimum acceptable diet (p&lt;0.01). Conclusion: Complimentary feeding practices are inadequate and thus, require an intervention of healthcare providers with better involvement.

A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda.

The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6-23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12-23 months) were more likely to use MNP than those of younger children (aged 6-11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.

Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Northern Tanzania: Cohort study.

IntroductionChildhood undernutrition is a major public health problem especially in low and middle-income countries (LMIC). The prevalence of early introduction of complementary feeding, low meal frequency, and low dietary diversity are frequent in LMICs. The effect of inappropriate complementary feeding practices on the nutritional status of children is not well documented in East African countries including Tanzania. Therefore, this study aimed at determining the effect of inappropriate complementary feeding practices on the nutritional status of children aged 6–24 months in urban Moshi, Tanzania.MethodologyA retrospective cohort study was done using the Pasua and Majengo cohorts of mother-child pairs in urban Moshi who were enrolled from 2002 to 2017. About 3355 mother-child pairs were included in the analysis. Appropriate complementary feeding practices were assessed using WHO IYFP indicators such as age at introduction of solid, semi-solid, or soft foods, minimum dietary diversity, and minimum meal frequency. Nutritional status (stunting, wasting, and underweight) was determined. Multilevel modeling was applied to obtain the effect of inappropriate complementary feeding practices on the nutritional status of children and to account for the clustering effect of mothers and children and the correlation of repeated measures within each child.ResultsMajority of the children (91.2%) were given soft/semi-solid/solid foods before six months of age, 40.3percent had low meal frequency, and 74percent had low dietary diversity. Early introduction of complementary food at age 0–1 month was statistically significantly associated with higher risks of wasting and underweight (ARR 2.9, 95%CI 1.3–6.3; and ARR 2.6, 95% CI 1.3–5.1 respectively). Children with low minimum meal frequency had higher risks of stunting, wasting, and underweight (ARR 2.9, 95%CI 2.3–3.6; ARR 1.9, 95%CI 1.5–2.5 and ARR 1.9, 95%CI 1.5–2.4 respectively). Children with low minimum dietary diversity were more likely to be stunted than is the case with their peers who received the minimum dietary diversity (ARR 1.3, 95% CI 1.01–1.6).ConclusionThere were a high proportion of children, which were fed inappropriately; Inappropriate complementary feeding practices predisposed children to undernutrition. Our study supports the introduction of complementary feeding, providing minimum dietary diversity, and minimum feeding frequency at six months of age as important in improving the nutritional status of the children.

Complementary feeding in Kongwa, Tanzania: Findings to inform a mycotoxin mitigation trial.

Complementary feeding of 6‐ to 24‐month‐old infants and young children with adequate, safe and developmentally appropriate food is essential to child health. Inappropriate complementary foods and feeding practices are linked to the high incidences of undernutrition among infant and young children in most developing countries, including Tanzania. Mycotoxin risk is an additional concern, given the documented presence of aflatoxin and fumonisin in food systems of Africa, especially maize and groundnut. In preparation for a trial of mycotoxin mitigation, we conducted focus group discussions and recipe trials to explore complementary foods and feeding practices in Kongwa, a rural district of central Tanzania. Sixty mothers of infants from 6 to 18 months of age in five villages across the district were purposefully sampled. During focus group discussions, mothers reported to mostly feed their children with cereal and groundnut‐based foods as thin or thick porridges. The most common porridge preparations contained cereal (mostly, maize) ranging from 66.7% to 80.0% by weight and groundnuts from 7.7% to 33.3%. The ratio of cereal to groundnut ranged from 3:1 to 4:1. For the recipe trial sessions, mothers chose similar ingredients reported during discussions to prepare complementary foods. The reliance on maize and groundnuts in complementary foods predisposes the children to undernutrition and exposure to aflatoxins and fumonisins. These formative research results suggest multiple intervention points to improve complementary feeding and reduce mycotoxin exposure in this population, including education messages package on feeding practices, mycotoxin control practices and complementary food formulation.

Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth.

The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.

Prevalence of Minimum Meal Frequency Practice and Its Associated Factors among Children Aged 6 to 23 Months in Ethiopia: A Systematic Review and Meta-analysis.

Background. Inappropriate complementary feeding practices are amongst the key causes of child undernutrition. It rises the risk of undernutrition, illness, and mortality among children. Objectives. This study was aimed to determine the pooled prevalence of MMF practice and associated factors among children aged 6 to 23 months in Ethiopia. Methods. The search was conducted by using the following electronic databases; PubMed/MEDLINE, HINARI, EMBASE, Google Scholar, Web of Science, Scopus, African journals, and Google for grey literature. The publication bias was determined by using a funnel plot and Egger’s test. The heterogeneity between the studies was checked by using I2 statistic. The subgroup analysis was done by sample size, region, and year of publication. Result. A total of 20 studies with 12 656 study participants were included in the present systematic review and meta-analysis. The pooled prevalence of MMF practice among children aged 6 to 23 months in Ethiopia was estimated to be 63.80% (95%CI: 56.59, 71.01). PNC visit (AOR = 1.90, 95%CI [1.31, 2.49]), wealth index (AOR = 2.11, 95%CI [1.42, 2.81]) and age of child (AOR = 5.75, 95%CI [4.25, 7.26]) were factors significantly associated with MMF among children aged 6 to 23 months. Conclusion. The findings showed that the pooled prevalence of MMF among children aged 6 to 23 months in Ethiopia was relatively low. PNC visit, wealth index and age of child were factors significantly associated with MMF among children aged 6 to 23 months. Therefore, community-based health education concerning the recommended MMF among children aged 6 to 23 months is required to take place.

Effects of Nutrition Education on Improving Knowledge and Practice of Complementary Feeding of Mothers with 6- to 23-Month-Old Children in Daycare Centers in Hawassa Town, Southern Ethiopia: An Institution-Based Randomized Control Trial.

Undernutrition and hidden hunger threaten the survival, growth, and development of children, young people, economies, and nations. Inappropriate complementary feeding practice due to poor maternal knowledge and awareness in combination with low income and infectious disease is the contributing factor for child undernutrition. Hence, this study was aimed at determining the effect of nutrition education on improving the knowledge and practice of complementary feeding of the mothers with 6- to 23-month old children in daycare centers of Hawassa Town, Southern Ethiopia. An institution-based randomized control trial design was employed. Daycare centers were randomly allocated for the intervention group and the control group. Among the total daycare centers in the town, five were assigned to receive nutrition education and the rest five for the control group (CG). The simple random sampling technique used to select individual participants from each daycare center. Two hundred (200) mother-child pairs (100 for each group) were recruited. Sociodemographic and economic variables were collected by the structured questionnaire. Knowledge of appropriate complementary feeding was assessed by seven knowledge questions. Appropriate complementary feeding practice was assessed by adapting Alive and Thrive Infant and Young Child Feeding (IYCF) practice guidelines. Nutrition education was given for four consecutive months by using Alive and Thrive IYCF guidelines. Data were analyzed by the SPSS software program version 20. The chi-squared test was used to test the significant differences in the proportion of good knowledge and good practice of complementary feeding and good dietary diversity between two groups. The independent t test was used to test the significant differences in mean dietary diversity between two groups. At 95% confidence interval, p < 0.05 was considered statistically significant. The results revealed that the proportion of mothers with good knowledge of appropriate complementary feeding was increased from 59% at pretest to 96% at posttest and the appropriate complementary feeding practice was improved from 54% at pretest to 86% at posttest in IG. There was no change in the knowledge and practice of complementary feeding practice in CG after four months. The proportion of mothers with good complementary knowledge was 54% both at pretest and at posttest and good complementary feeding practice was 51% and 52% at pre- and posttest in CG, respectively. There was no significant difference (p > 0.05) on complementary feeding knowledge and practice between two groups at pretest, while the difference was highly significant (p < 0.05) at the posttest. In conclusion, providing nutrition education improved the appropriate complementary feeding knowledge and practice of mothers. In recommendation, government and other partners working on sustainable child nutrition reduction should focus on the nutrition education to improve the knowledge and appropriate complementary feeding practice including daycare centers.