Optimal Complementary Feeding Research Articles

Dietary diversity and associated factors among infants and young children in three West African countries

Providing children healthy diversified diets is important for their optimal growth and development. The high prevalence of under-nourishment during the critical early life period is of serious concern in West Africa. We assessed the level of dietary diversity and associated factors for children aged 6–23 months in Côte d’Ivoire, Niger and Senegal. Prior 24 h dietary intake was assessed for 3,528 children (Côte d’Ivoire: N = 118; Niger: N = 763; Senegal: N = 2,647) using the Diet Quality Questionnaire survey tool administered to primary caregivers. Cluster random sampling was conducted for urban and rural areas in Niger and Senegal and simple random sampling was used in Côte d’Ivoire, where only rural households were selected. Survey data were analyzed to determine children’s intake of items from eight food groups: breast milk; grains, roots, tubers and plantains; pulses, nuts and seeds; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum Dietary Diversity (MDD) was assessed based on the consumption of ≥5 of the 8 food groups. In all countries, the majority of children were ≥ 12 months of age and from rural households. Children from poor/very poor households ranged from 32.4 to 41.9%. MDD prevalence was 54.2% in Côte d’Ivoire, 33.3% in Niger and 30.8% in Senegal. In all three countries, children 12–23 months had significantly higher consumption of six of the food groups, compared to those 6–11 months, and children ≥12 months had a higher likelihood of MDD, compared to infants, in Niger (aOR = 4.25; 95% CI: 2.46, 7.36) and Senegal (aOR = 2.69; 95% CI: 2.15, 3.35). MDD prevalence was higher among children in urban, compared to rural, areas in Niger (p = 0.020) and Senegal (p < 0.001) and significantly higher in the wealthiest, compared to poorest, households. This study suggests most young children in Côte d’Ivoire, Niger and Senegal are not receiving an adequately diversified diet, with a reliance on starchy staples and lower intake of high-quality protein sources. Our results highlight socio-economic barriers to attaining dietary diversity in these settings and stress the urgent and continuing need for investments in strategies that support optimal complementary feeding practices.

Level of completion of a continuum of age-appropriate infant feeding practices and barriers among breastfeeding mothers in Ethiopia: a mixed methods study

BackgroundEthiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face.MethodsIn this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently.ResultsThis study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers’ complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers.ConclusionThe level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers’ optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers’ education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.

Identifying and understanding barriers to optimal complementary feeding in Kenya.

Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008to 31% in 2023. The Kenyan Ministry of Health, GAINand UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal-source foods could be improved. Ethnographic data were analyzed to identify socio-cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user-friendly and low-cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal-source foods. Furthermore, it emphasizes the need for a multi-sectoral approach in enacting policies and programmes that address these barriers.

Optimal complementary feeding practices of children aged 6-23 months in three agro-ecological rural districts of Jimma zones of southwest Ethiopia.

Despite the critical importance of complementary feeding, large proportions of children in developing countries are sub-optimally fed during 6-23 months of age. In Ethiopia, even though the government has been rolling out infant and young child feeding (IYCF) guidelines, the proportion of mothers adhering to the recommended optimal practices and its associated factors have not been assessed in different agro-ecological areas. Hence, the present study aimed to determine optimal complementary feeding practices and associated factors in three agro-ecological rural districts (high, mid and lowland) of southwest Ethiopia. A community-based cross-sectional study was carried out among 845 mothers-index young children 6-23 months Jimma zone. Multistage sampling was employed to select the study participants. Structured and pretested questionnaires were used to collect data and entered into Epi Data V.1.4.4.0. The data were analysed using SPSS version 20. Binary and multivariable logistic regressions were used to identify factors associated with optimal child-feeding practices. The significance of the association was determined at P < 0⋅05. The overall proportion of optimal complementary feeding practice (OCFP) was 9⋅4 % at 95 % CI (7⋅19, 11⋅08). The timely initiation of complementary feeding, minimum meal frequency, minimum dietary diversity and minimum acceptable diet was 52⋅2, 64⋅1, 17⋅2 and 12⋅2 %. Multivariable logistic regression showed that being in the highland districts, having good maternal knowledge, and mothers having primary school education, having a family size of less than six were positively associated with optimal complementary feeding practices. The findings showed that OCFP was low, especially in the midland agro-ecological districts.

Peningkatan Pengetahuan Ibu tentang Pengelolaan Makanan Pendamping ASI (MP-ASI)

Effort of the optimalization the growth and development of children required adequate nutritional intake. Breast milk and complementary feeding were the main sources in supporting child growth. The timing to starting complementary feeding greated affects the quality of a child's health. The practice of giving complementary feeding early can increased the risk of high incidence of infections and growth disorders. Children who did not got optimal complementary feeding, 6.5 times more likely to experience growth disorders. Lack of understanding in the management of infant and child food, low education, socioeconomic factors were factors that cause malnutrition and infection problems in children under five, especially under the age of 24 months. The purpose of this community service was increased the knowledge of breastfeeding mothers and mothers who have children under the age of 2 (two) years about the Management of Complementary Feeding. The form of community service activitie was socialization method. The socialization method through face-to-face used presentation media and leaflets. The pretest was carried out before the extension activities with the result that the mother's level of knowledge about the management of complimentary feeding before the delivery of the extension material was in the Poor category with the average value of the evaluation results reaching 50.8%. The results of the posttest after being given the extension material showed an increase in the mother's knowledge about the management of complementary feeding with an average evaluation value of 85%, which was in the good category. There was an increase of 34.2% towards the increase in mother's knowledge about the management of complementary feeding. The result of this community service that providing information about the management of complementary feeding was very necessary so that breastfeeding mothers having good knowledge about the management of complementary feeding and can contribute to changes in mother's behavior in dealing with the stages of giving complementary feedingto their children. Then, giving the right complementary feeding can had been an impact on health optimal child development.

Optimal complementary feeding practices and associated factors among mothers having children 6 to 23 months, south WOLLO zone, Dessie ZURIA, Ethiopia

IntroductionOptimal complementary feeding practice is a child feeding practice that fulfills the minimum dietary diversity, the minimum meal frequency, continuing breastfeeding with complementary feeding, and initiation of complementary feeding from 6 to 8 months. MethodA community-based comparative cross-sectional study was conducted on a total of 732 randomly selected mothers having children 6 to 23 months of age from March 10 to April 21 /2021.Data were collected using a pre-tested interviewer-administered questionnaire. Data entry was performed by using Epi data version 3.1 and was exported to Stata version 14.1. Descriptive statistics were done. Multivariable Logistic regression was used to predict the role of independent variables on optimal complementary feeding. Findings with a p-value <0.05 at a 95% confidence interval (CI) were considered statistically significant in the final model. ResultThe overall proportion of mothers with optimal complementary feeding practice was 18.1% (95% C I 15.3% – 21.0). Only 90 (25.1%, 95% CI = 20.6–29.7) of mothers were found to have optimal complementary feeding practice in NGO supported kebeles but only 37 (10.8%, 95% CI = 7.5–14.1) practiced optimal complementary feeding is not NGO-supported kebeles. Mothers from Kebeles with no NGO support were 46% (AOR = 0.54, 95% CI 0.31, 0.96) less likely to practice optimal complementary feeding. On the other hand, mothers of children aged20–23 months were four times (AOR = 4.47, 95% CI 2.02–9.91) more likely to practice optimal complementary feeding than mothers having children 6–8 months of age. Practice implicationsDifferent interventions have been implemented by governmental and non-governmental organizations to improve this condition in Dessie Zuria District. But, there is limited data on the extent to which intervention by governmental and non-governmental organizations reduces this improving condition. The aim of this study was to assess the Optimal Complementary Feeding Practice and Associated Factors among Mothers Having Children Aged 6–23 Months, Ethiopia 2021. ConclusionOptimal complementary feeding practices among mothers in NGO-supported kebeles were higher than not supported kebeles. Therefore, strengthening and scaling up the program to not-supported kebeles is recommended to improve the optimal complementary feeding practiced.

Optimal complementary feeding practices among caregivers and their children aged 6–23 months in Kisoro district, Uganda

BackgroundThere are many risk factors for stunting, and studies most often corroborate complementary feeding practices as a significant risk factor. Information on the prevalence of optimal complementary feeding practices and factors that lend to caregivers meeting their requirements in Kisoro district, a district with high stunting rates, is mostly lacking.MethodologyAn analytical cross-sectional study that used secondary data from a USAID-funded project. Entries for 384 caregivers of children aged 6–23 months in Kisoro district were abstracted from the project database. The data was analysed using SPSS version 20. The association between independent factors and optimal complementary feeding practices was determined using multivariable logistic regressions at the three levels of the Socio-Ecological Model.FindingsAlthough 95% of the infants were introduced to semi-solid foods promptly, their diet was nutritionally inadequate as evidenced by the low minimum dietary diversity of 4.43%. Some of the key covariates associated with these outcomes included, the type of occupation (AOR = 21.21; CI = 2.03—221.26; p = 0.011), community groups (AOR = 0. 43; CI = 0.22—0.83; p = 0.012), not being married (AOR = 13.25; CI = 1.76—100.25; p = 0.012), age of the child (AOR = 2.21; CI = 1.1—4.45; p = 0.026); among others.ConclusionThe prevalence of MAD and MDD was very low in Kisoro district, even compared to national figures, putting these children at a very high risk of stunting. Increased advocacy is needed to support the community-level implementation of the IYCF guidelines.

Fathers’ Complementary Feeding Support Strengthens the Association Between Mothers’ Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria

ABSTRACTBackgroundEvidence about the effects of mothers’ decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers’ decision-making autonomy and the practice of complementary feeding.ObjectivesThis study examined the moderation effect of fathers’ complementary feeding support on the association of mothers’ decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers’ and fathers’ perspectives of mothers’ autonomy and fathers’ complementary feeding support.MethodsData were from cross-sectional surveys of 495 cohabiting parents of children aged 6–23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents.ResultsThe moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents’ perspectives of mothers’ autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents’ perspectives of fathers’ complementary feeding support.ConclusionsIn Nigeria, high levels of fathers’ complementary feeding support strengthen the association of mothers’ decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662).

Fathers’ Complementary Feeding Support Moderates the Association Between Mothers’ Autonomous Household Decision-Making and Optimal Complementary Feeding

ObjectivesThe evidence base on the role of maternal decision-making autonomy in optimal complementary feeding practices is not consistent, leaving questions about moderation by social support. The objective of this research is to examine the moderation effect of fathers’ complementary feeding support on the association of maternal decision-making autonomy with complementary feeding indicators. MethodsWe used logistic regression interaction models to examine whether complementary feeding support was a moderator of the association between decision-making autonomy and complementary feeding using data from endline (cross-sectional) surveys administered to 495 cohabiting mothers and fathers of children aged 6–23 months in Igabi local government area (LGA), Kaduna State, Nigeria. The 12-month Alive & Thrive intervention engaged fathers through complementary feeding messages from religious and community leaders, text, and voice messages. Mothers received home visits and feeding bowls from community health extension workers (CHEWs). The intervention also included mass media messaging on radio and TV. ResultsMaternal decision-making autonomy was associated with minimum dietary diversity (AOR, 1.15; 95% CI, 1.00, 1.32), minimum meal frequency (AOR, 1.31; 95% CI, 1.11, 1.53), minimum acceptable diet (AOR, 1.24; 95% CI, 1.09, 1.41) and feeding children fish (AOR, 1.23; 95% CI, 1.08, 1.40). Complementary feeding support was associated with minimum dietary diversity (AOR, 1.38; 95% CI, 1.08, 1.75), minimum meal frequency (AOR, 1.34; 95% CI, 1.05, 1.70), minimum acceptable diet (AOR, 1.40; 95% CI, 1.14, 1.73), feeding eggs (AOR, 1.49; 95% CI, 1.16, 1.90) and feeding fish (AOR, 1.30; 95% CI, 1.06, 1.60). In the interaction models, the simple slopes for decision-making were significant for most of the complementary feeding indicators when fathers offered > 2 types of support. ConclusionsWithin the context of Kaduna, high levels of fathers’ complementary feeding support strengthen the association of maternal decision-making autonomy with complementary feeding practices. Funding SourcesThis research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation, Irish Aid, and other donors.

Male Partner Involvement in Complementary Feeding Practices Among Households With Children Aged 6–24 Months in Abim District, Uganda

ObjectivesGeneral Objective: To determine the level of male partner involvement in complementary feeding practices and associated factors among households with children aged 6–24 months in Abim District so as to devise most effective strategies, approaches and interventions for encouraging male partner involvement with a view of improving adoption of optimal complementary feeding practices in children aged 6–24 months. Research Questions - What is the level of male partner involvement in complementary feeding practices among households with children aged 6–24 months? - What factors are associated with male partner involvement in complementary feeding practices among households with children aged 6–24 months? MethodsA cross-sectional study involving both quantitative (382 mothers) and qualitative (2 FGDs and 2 KIIs) approaches was conducted. Data entry was done and checked for completeness and consistency using Epi Data 3.0. Data analysis was done using SPSS version 20. Descriptive statistics were used to define the characteristics of study participants. At bivariate analysis, Pearson’s chi square tests were used to establish the association between the dependent and each independent variable. At multivariate analysis, a binary logistic regression was executed to establish factors associated with male partner involvement in complementary feeding using odds ratios. Strength of association was determined at 5% level of significance (p < 0.05). ResultsThe level of male partner involvement in complementary feeding in this study was good (68%). It was associated with; tertiary education of mother (OR = 1.38, CI 95% = 0.01 to 0.08; p = 0.00), mothers in formal employment (OR = 1.03; CI 95% = 1.001 t0 3.05: p = 0.001), husbands in formal employment (OR = 1.75; CI 95%: 1.05 to 2.89; p = 0.021) and husbands aged between 25–29 years (OR = 3.73; CI 95% = 1.96 to 7.07; p = 0.002). ConclusionsMale partner involvement in complementary feeding in Abim district is good. It is associated with; formal employment for mothers and their partners, mothers with tertiary education, and husbands aged between 25–29 years. The government needs to strengthen multi-sectoral integration to address the gender gaps and barriers that hinder male partner involvement in the broader infant and young child feeding practices. Funding SourcesNone.

Determinants of Complementary Feeding Practices and Nutritional Status of Children 6 – 23 Months in Pastoralist Communities of Isiolo, Kenya

Optimal complementary feeding practices play a vital role in the nutritional status of young children. In Kenya, significantly higher rates of acute malnutrition have been reported among pastoralist communities, particularly among children aged 6-23months. There is inadequate complementary feeding data on pastoralist communities despite their vulnerability. The objective of the study was to establish the determinants of complementary feeding practices and nutritional status of children 6-23 months among pastoralist communities of Isiolo County, Kenya. A cross-sectional analytical study using two-stage cluster sampling methodology was applied to select a sample of 288 children aged 6-23 months from pastoralist communities. Data on the socio-demographic characteristics of the study population, complementary feeding practices and anthropometric measurements of the children aged 6-23 months was collected and analysed. Overall, the prevalence of stunting, underweight and wasting was 19.1%, 7.3% and 5.2% respectively. A variation in malnutrition prevalence was observed with age of children, with the 18-23month age group showing a higher prevalence of all forms of undernutrition. Male children had significantly higher proportions of underweight and stunting (p ≤ 0.05). Complementary feeding practices were sub-optimal - minimum meal frequency (60.4%), minimum dietary diversity (35.4%) and minimum acceptable diet (25.3%). Child age, child sex, caregiver’s age, and caregiver education level were significant determinants for complementary feeding practices and nutritional status of children 6-23months (p ≤ 0.05). We recommend that community based approaches targeting pastoralist communities should address the basic cause of child malnutrition through nutrition education and women empowerment initiatives.

Complementary feeding practices and associated factors among children aged 6-23 months in rural Haramaya district, Eastern Ethiopia: A community-based cross-sectional study.

Background: The age of children up to 59 months is a critical period for children's growth and development and the age when optimal complementary feeding is crucial. Aim: To assess optimal complementary feeding practices and associated factors among children aged 6-23 months in rural Haramaya district, Eastern Ethiopia. Methods: A community-based cross-sectional study was conducted. Statistical Package for Social Science (SPSS) version 24 was used for the analyses. Bivariable and multivariable logistic regression analysis were conducted at p-value < 0.05 and an Adjusted Odd Ratio (AOR) with a 95% Confidence Interval (CI). Results: The percentage of mothers that practiced optimal complementary feeding practices was 53.5% (95% CI: 49.2%, 57.6%). Average monthly income of the family, $37.5 to $75 (AOR = 0.52, 95% CI: 0.28, 0.98), institutional delivery (AOR = 1.61, 95% CI: 1.06, 2.46), postnatal care follow-up (AOR = 2.53, 95% CI: 1.67, 3.82), having an awareness about IYCF (AOR = 3.05, 95% CI: 1.85, 5.02), less than 30 min foot-walking to reach health facility (AOR = 2.61,95% CI: 1.65, 4.09), separate child's feeding plate (AOR = 1.75, 95% CI: 1.16, 2.64), and attendance of Infant and Young Child Feeding demonstration (AOR = 2.02, 95% CI: 1.33, 3.07) were significantly associated with optimal complementary feeding practices. Conclusion: The magnitude of optimal complementary feeding practices was below the minimum recommended level for the growth and development of children in the study area. Lack of access to and underutilization of maternal and child healthcare services were significant risk factors for suboptimal complementary feeding practices. Maternal and child health services would be essential to mitigate suboptimal feeding practices for children aged 6-23 months.

Meat Helps Make Every Bite Count

New evidence-based dietary guidelines for feeding infants from birth to 24 months old recommend meat as an ideal first complementary food. Starting at 6 months old, infants need a variety of nutrient-dense foods, including foods that are rich in bioavailable iron and zinc. Because infants and toddlers eat small quantities of foods, it is critical to make every bite count in the early years. New parents are often unsure of optimal complementary feeding practices. The goal of this article is to review the role of red meat as a potential first complementary food for infants.

Complementary Feeding Indicators in Relation to Micronutrient Status of Ghanaian Children Aged 6-23 Months: Results from a National Survey.

Background: Optimal complementary feeding is critical for adequate growth and development in infants and young children. The associations between complementary feeding and growth have been studied well, but less is known about the relationship between complementary feeding and micronutrient status. Methods: Using data from a national cross-sectional survey conducted in Ghana in 2017, we examined how multiple WHO-recommended complementary feeding indicators relate to anemia and the micronutrient status of children aged 6–23 months. Results: In total, 42%, 38%, and 14% of the children met the criteria for minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), respectively. In addition, 71% and 52% of the children consumed iron-rich foods and vitamin A-rich foods, respectively. The prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA) and vitamin A deficiency (VAD) was 46%, 45%, 27%, and 10%, respectively. Inverse associations between MMF and socio-economic status were found, and MMF was associated with an increased risk of ID (55%; p < 0.013) and IDA (38%; p < 0.002). Conclusion: The pathways connecting complementary feeding and micronutrient status are complex. Findings related to MMF should be further investigated to ensure that complementary feeding programs account for the potential practice of frequent feeding with nutrient-poor foods.

Evaluating the pathways linking complementary feeding practices to obesity in early life.

The complementary feeding period, when solids and liquids other than breast milk and formula are added to the infant diet, is an important development window shaping infant growth and weight gain, metabolic development, and lifelong eating practices. Yet, relatively little is known about how the timing and types of foods offered to infants at this stage may shape their growth and subsequent risk of developing obesity. This narrative review describes the existing literature on complementary feeding practices, discusses potential biological and behavioral pathways linking complementary feeding practices to the development of obesity, and offers potential avenues for intervention. While further research is needed to more fully understand optimal complementary feeding practices, existing evidence supports the importance of healthful early feeding practices in the physiological and behavioral regulation of growth and metabolism and the need for early intervention to prevent the development of obesity.

Using formative research to design context-specific animal source food and multiple micronutrient powder interventions to improve the consumption of micronutrients by infants and young children in Tanzania, Kenya, Bangladesh and Pakistan.

Optimal complementary feeding practices including consumption of multiple micronutrient powders (MNP) are recommended to improve micronutrient intake by infants and young children (IYC) 6–23 months. Formative research was used to design the behaviour change strategy to improve IYC micronutrient intake for the multicountry ENRICH project in rural impoverished areas of Tanzania, Kenya, Bangladesh and Pakistan. Employing a qualitative approach with multiple methods and guided by a social ecological framework, the study was conducted in several phases: data collection in the community, household and health facilities, initial analysis and household trials (HHT). Results found limited use of animal source foods (ASF) for feeding IYC and MNP largely unavailable. Although cost constrained access to ASF, potential more affordable context‐specific ASF options were identified in each setting. Caregivers associated ASF with many positive attributes for IYC, but barriers to feeding them included lack of caregiver time and knowledge of specific preparation techniques, and limited advice from health workers. Feeding practices were identified that used time‐efficient, specific preparations for eggs and other ASF, and demonstrated good initial acceptability and feasibility during HHT. Testing MNP in HHT found good initial feasibility and acceptability and provided an understanding of the facilitators and constraints for preparing, feeding and promoting MNP. In conclusion, formative research led to the design of context‐specific ASF and MNP complementary feeding promotion strategies to improve IYC consumption of micronutrients by identifying the practices, benefits, motivations and alternative actions to overcome the barriers in each setting.

Effect of complementary feeding behavior change communication delivered through community-level actors on dietary adequacy of infantsin rural communities of West Gojjam Zone, Northwest Ethiopia: A cluster-randomized controlled trial.

BackgroundAttaining the recommended level of adequacy of the infant’s diet remains a serious challenge in most developing countries. Complementary foods, particularly in developing countries, are inadequate in quality and quantity that can result in adverse health and nutrition consequences in infants. This could be not only because of lack of food but also associated with caregiver’s poor knowledge, harmful cultural norms and behaviors on infant feeding. The promotion of optimal complementary feeding through behavior change interventions is a global health priority. However, many of the interventions targeted only mothers/caregivers of infants, and studies that engaged other family members are limited worldwide. Moreover, such interventions are scarce in developing countries, including Ethiopia. This trial aimed to evaluate the effectiveness of complementary feeding behavior change communication delivered through community-level actors on the dietary adequacy of infants.MethodsWe conducted a cluster-randomized controlled trial in rural communities of West Gojjam Zone, Northwest Ethiopia. Trial participants in the intervention clusters received complementary feeding behavior change communication for 9 months whereas those in the control clusters received only the usual care. Trained women development army leaders delivered the intervention. A pre-tested, structured interviewer-administered questionnaire was used for data collection. Generalized estimating equations regression analyses adjusted for baseline covariates and clustering were used to test the intervention effects.ResultsThe intervention showed positive statistically significant effects on the consumption of dairy products [RR = 1.8; 95% CI: 1.04–3.13], eggs [RR = 3; 95% CI: 1.35–6.56], vitamin A-rich fruits and vegetables [RR = 2.7; 95% CI: 1.17–6.1], other fruits and vegetables [RR = 5; 95% CI: 2.49–10.58] and animal-source foods [RR = 2; 95% CI: 1.39–2.87]. The proportions of infants who achieved minimum dietary diversity [RR = 3; 95% CI: 1.34, 7.39], minimum meal frequency [RR = 2.4; 95% CI: 1.37–4.29], and minimum acceptable diet [RR = 2.7; 95% CI: 1.13–7.23] were significantly higher in the intervention as compared to control groups.ConclusionsComplementary feeding behavior change communication delivered through community-level actors significantly improved the dietary adequacy of infants.Trial registrationClinicalTrials.gov, NCT03488680. Registered 5 April 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03488680.

Complementary feeding practices and nutritional status of young children in a community in Sokoto

Background: Complementary feeding is the cornerstone of child’s nutrition. Most malnourished children had their predicament originating from the period of transition from breastfeeding to family diet.&#x0D; Objectives: To determine the complementary feeding practices and nutritional status of young children in Gwiwa community.&#x0D; Materials and Methods: This cross-sectional study was carried out in Gwiwa community, Wammakko LGA, Sokoto State between January and June, 2018. Three hundred and ten mothers with their children aged 6 –36 months were interviewed using structured interviewer - administered questionnaire and the children’s nutritional status was assessed using WHO classification of malnutrition. Data was analysed using SPSS version22.0.A p-value ≤0.05 was taken as significan.&#x0D; Results: One hundred and forty (45.2%) respondents were aged 15 – 24years and 168(54.2%) were of low socio-economic class. There were 190 males and 120 females with 66 (21.3%) children exclusively bre as t - fed for 6months. The mean age of cessation of breast feeding was 17.8 ±3.6 months. One hundred and sixty-nine (54.5%) children commenced complementary feeding at 6-8month of age with the mean age of 5.7(±2.6) months. One hundred and eighty-four (59.4%) used plain pap with 41.2% fed more than 3 times per day. Eighty-two (26.5%), 56(18.1%) and 76 (24.5%) children were underweight, wasted and stunted respectively.&#x0D; Conclusion: The complementary feeding practices were suboptimal in this community and might explain the poor nutritional status of their under- fives. Efforts should be geared towards optimal complementary feeding practices in this community.&#x0D; Key words: Complementary, Feeding, Practice, Nutritional, Status, Under-5.

&lt;p&gt;Level and Predictors of Mothers’ Knowledge and Attitude on Optimal Complementary Feeding in West Gojjam Zone, Northwest Ethiopia&lt;/p&gt;

&lt;p&gt;Level and Predictors of Mothers’ Knowledge and Attitude on Optimal Complementary Feeding in West Gojjam Zone, Northwest Ethiopia&lt;/p&gt;

Determinants and Current Level of Optimal Complementary Feeding Practices among Lactating Mothers of Children in Ambo Town, Oromia, Ethiopia

An appropriate diet is critical in the growth and development of children especially in the first two years of life. Poor complementary feeding of children aged 6 months - 23 months contributes to the characteristics negative growth trends and deaths observed in developing countries. Therefore, this study aimed to assess determinants and current level of optimal complementary feeding practices among mothers of children aged 6 months to 23 months in Ambo town, Oromia Region. The study used cross sectional study design and targeted 336 mothers with children 6 months - 23 months olds. Information from the respondents were collected using standard questionnaire. Data entry and analysis was done using SPSS version 21.0 windows statistical software. All (100%) the children 6 months - 8 months old had received solid, semi-solid/soft foods. The minimum meal frequency was attained by 88.3% (95% CI 84.3-91.4) whereas the minimum dietary diversity was attained by 17.9% (95% CI 14.1-22.5). The minimum acceptable diet was attained by 15.4% (95% CI 11.9-19.8). Maternal knowledge on: importance of breastfeeding (87.3%); age of introduction of complementary foods (85.4%) and correct meal frequency for age (74.5%) was high. On the contrary, knowledge on the importance of enriching complementary foods (34.5%) was low. Mothers who knew the importance of a diverse diet were likely (chi-square test; p=0.001) to feed their children on a diverse diet. On the other hand, mothers who knew the importance of enriching complementary foods were likely to feed their children on a minimum acceptable diet (chi-square test; p = 0.007) and maternal knowledge on enriching complementary foods (OR = 3.41, p = 0.040) were significant predictors of consumption of Vitamin A rich foods, minimum meal frequency and minimum acceptable diet, respectively. Behaviour change and communication involving all the stakeholders in infant and young child feeding should be emphasized. Messages on appropriate feeding practices should include importance of dietary diversity