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Complementary feeding practices and
associated factors among children aged
6-23 months in rural Haramaya district,
Eastern Ethiopia: A community-based
cross-sectional study
Mahdi Ebroshe
1
, Lemessa Oljira
2
, Bezatu Mengiste
2
, Hassen
Abdi Adem
2
, Addisu Alemu
2
and Gelana Fekadu
3
Abstract
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 feed-
ing 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 feed-
ing practices. Conclusion: The magnitude of optimal complementary feeding practices was below the minimum recom-
mended 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.
Keywords
Complementary feeding, children of 6–23 months, Haramaya district, Ethiopia
Introduction
Around six months of age, the infant’s energy and nutri-
tional needs exceed those of breast milk, and complemen-
tary foods meet these needs (WHO, 2019). The child’s
age up to 59 months is a critical window period for the
growth and development of the children. It is a time
period when micro and macronutrient deficiencies and
related childhood diseases contribute to the highest rates
of malnutrition among children under the age of five
years worldwide(Black et al., 2008).
The analysis of Ethiopian demographic and health data
showed that the national rates of stunting, underweight,
and wasting; 44%, 29%, and 10% in 2011 versus 38%,
24%, and 9% in 2016 respectively (Central Statistical
Agency/CSA/Ethiopia and ICF, 2016). Furthermore, the
national trends of Minimum Acceptable Diet (MAD)
among children aged 6–23 months, increased by 4% in
2011 versus 7% in 2016. Likewise, the trend in minimum
dietary diversity (MDD) for children was improved from
1
Public Health Expert, Oromia Regional Health Bureau, Addis Ababa,
Ethiopia
2
School of Public Health, College of Health and Medical Sciences,
Haramaya University, Harar, Ethiopia
3
School of Nursing and Midwifery, College of Health and Medical
Sciences, Haramaya University, Harar, Ethiopia
Corresponding author:
Gelana Fekadu, School of Nursing and Midwifery, College of Health and
Medical Sciences, Haramaya University, Bote, Harar 235, Ethiopia.
Email: fekadugelana4@gmail.com
Original Article
Nutrition and Health
1–8
© The Author(s) 2022
Article reuse guidelines:
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DOI: 10.1177/02601060221082373
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14% in 2011 versus 18% in 2016(Central Statistical
Agency/CSA/Ethiopia and ICF, 2016).
The magnitude of optimal feeding practices in Ethiopia is
low but varies by setting with a national prevalence of 4%
(Central Statistical Agency/Ethiopia and ICF International,
2012), and 7% in the Amhara Region (Demilew et al., 2017),
10.8% in the Tigray Region (Mekbib et al., 2014), 9.5% in
the Oromia Region (Kassa et al., 2016), and 13.5% in the
Southern Nations, Nationalities, and People’sRegion
(Chaimiso et al., 2017).
Studies demonstrated factors associated with optimal
complementary feeding practices include; maternal literacy
(Liaqat et al., 2007), exclusive breastfeeding practices, ante-
natal care (Dagne et al., 2019), postnatal care, media expos-
ure, institutional delivery (Demilew et al., 2017), and family
size (Kassa et al., 2016, Mekbib et al., 2014). However, low
socioeconomic status, undesirable socio-cultural beliefs
(Kuriyan and Kurpad, 2012), and lower parental education
(Senarath and Dibley, 2012) have been identified as contrib-
uting factors to suboptimal complementary feeding practices.
Ethiopia has designed and implemented various pro-
grams and strategies to improve Infant and Young Child
Feeding (IYCF) practices, nutritional status, and related
factors (FMOH, 2004, 2016). However, suboptimal com-
plementary feeding practices and under nutrition of children
aged under five years remain a serious public health
problem in the country (Central Statistical Agency/
Ethiopia and ICF International, 2012).
Most previous studies conducted in Ethiopia have only
focused on urban areas (Abera, 2012; Dagne et al., 2019;
Girma et al., 2014; Mekbib et al., 2014; Mekonnen et al.,
2017; Semahegn et al., 2014; Shumey et al., 2013; Yemane
et al., 2014). However, the majority of the population
resides in a rural setting where access to healthcare is poor
and illiteracy is widespread (Central Statistical Agency/
Ethiopia and ICF International, 2012). Moreover, many of
the studies simply focused on either of the IYCF indicators;
early initiation of complementary feeding, minimum meal fre-
quency, and minimum dietary diversity (Demilew et al., 2017;
Moges, 2016; Molla et al., 2017; Roba et al., 2016; Semahegn
et al., 2014; Yemane et al., 2014; Yonas, 2015).
Hence, right timing, amount, and consistency remain
critical to optimal complementary feeding practices to
reduce and prevent child malnutrition (WHO, 2019).
However, literature is scarce in rural Ethiopia. Therefore,
this study was conducted to determine the prevalence of
optimal complementary feeding practices and identify asso-
ciated factors among children aged 6–23 months in a rural
Haramaya district, Eastern Ethiopia.
Methods
Study design and setting
A community-based cross-sectional study was conducted
from February 01 to 28, 2018 in a rural district of
Haramaya. The Haramaya district is located in the East
Hararghe zone of the Oromia Region, about 506 kilometers
east of Addis Ababa, the capital of Ethiopia. In 2017, the
district had a total population of 297,953 with an estimated
total number of children under one-year-old were 9,594 and
6–23 months were 16,984. Eight health centers, 33 health
posts, and 12 private clinics found in the district
(Unpublished data, Haramaya district health office, 2017).
Population, sample size, and sampling
All children aged 6–23 months who were permanent resi-
dents of Haramaya district were considered as the study
population. However, participants with severe physical
and mental illness (mothers or child pairs or both mother-
child pairs) were excluded.
The sample size was calculated using Epi Info version
7.1 with the following assumptions: 56.5%, the proportion
of optimal complementary feeding practices (Molla et al.,
2017); confidence level of 95%, the margin of error of
5%, design effect of 1.5 and non-response rate of 10%.
Hence, 554 participants were required to conduct the
study. Similarly, the sample size for factors associated
with optimal complementary feeding practices was com-
puted using the following assumptions: 80% power of the
study, 95% confidence level, 54%, the proportion of
optimal complementary feeding among those who attended
antenatal care service among the unexposed group and an
Adjusted Odd Ratio (AOR) of 2.05 (Abera, 2012) and
design effect of 1.5 with 10% non-response and accord-
ingly, 316 participants required for a second specific objec-
tive. Finally, we compared two sample sizes and used the
larger one. Hence, 554 participants were considered for
the study.
A two-stage stratified sampling technique was used to
recruit the study participants. First, out of 33 rural kebeles
(the smallest administrative unit after the district in the
Ethiopian context) in the district, 10 rural kebeles were ran-
domly selected by lottery method. Then, we allocate the
proportional sample size after determining the total
number of households having children aged 6–23 months
in each selected kebele by using the community health
information system registries available in each health
post. Finally, actual participants were recruited by using
a systematic sampling technique. Consequently, if more
than one eligible child was observed in a single household
during the data collection, one child was randomly selected.
Data collection tools and measurements
Data were collected from mother-child pairs through the
face-to-face interview method. Pretested structured ques-
tionnaires adapted from standardized tools (FAO, 2016;
WHO, 2010) (WHO’s IYCF indicators measurements
items and Food and Agricultural Organization (FAO)
child’s minimum dietary diversity scale using the
24-hours dietary recall method) were used for the data col-
lection. The questionnaire contains information on
2Nutrition and Health 0(0)
sociodemographic characteristics, maternal decision-
making autonomy, reproductive, healthcare-related
factors, and complementary feeding practices. The data col-
lectors were ten diploma nurses and supervised by two
trained bachelor’s degree holders in public health.
Complementary feeding practices: Measured and com-
puted based on WHO’s 2010 IYCF core indicators (WHO,
2010): Timely initiation of complementary feeding, MMF
(Minimum Meal Frequency), and MDD (Minimum Dietary
Diversity). Complementary feeding was considered optimal
when the participant meet the three indicators mentioned
above (initiated complementary feeding at 6 months of
age, had an acceptable standard of MMF, and fed the
child at least four out of seven food groups) and suboptimal
unless otherwise (Senarath and Dibley, 2012; WHO, 2010).
Timely initiation of complementary feeding: It was
assessed using a single dichotomous (yes/no) item asking
the mothers whether “solid or semi-solid or soft foods
with breast milk started for the child at the age of six
months”(WHO, 2010).
Minimum dietary diversity: Assessed against the FAO’s
minimum dietary diversity scale using the 24-hours dietary
recall method. The child’s mother was asked to list all foods
the child had eaten(at home or away) in the last 24 h before
the interview from listed seven food groups (cereals, roots,
and tubers, legumes and nuts, dairy products (milk, yogurt):
flesh foods (meat, fish, poultry, and liver/organ meats);
eggs; vitamins A–rich fruits and vegetables, and others
fruits and vegetables including dark leafy greens and vege-
tables) and the child who consumed at least four food
groups was considered as having a diversified diet and
not unless otherwise(WHO, 2010).
Minimum frequency of meals: Considered adequate for
non-breastfeeding children aged 6 to 23 months whose
mothers fed them at least four times solid or semi-solid or
soft foods/meals or cow milk in the last 24-hours prior to
an interview, and inadequate unless otherwise. Likewise,
considered adequate for breastfeeding children aged 6–8
months whose mothers fed them either semi-solid or soft
foods/meals or including breast milk at least two times in
the last 24-hours before the interview and inadequate
unless otherwise. Meals also include snacks (WHO, 2010).
Data quality control
Data collectors and supervisors were trained for three days
on the content of the tool and the data collection method.
The questionnaire was pre-tested on 5% of the random
samples (28 participants) in the district of Kurfa chele one
week before the actual study and modified accordingly.
The questionnaire was prepared in English and translated
into Afaan Oromo (local language) and then back into
English by two independent professional translators. The
data collected was checked manually on a daily basis for
completeness and consistency. Finally, data were double
entered by two independent data clerks, and the inconsis-
tencies have been fixed.
Data processing and analysis
Data were entered using Epi-Data version 3.1 and analysed
using SPSS version 24. Descriptive statistics (frequency,
percentage, mean, and standard deviations) were used to
describe the participants. Logistic regression analyses
were performed to identify factors associated with optimal
complementary feeding practices. All variables with a
p-value less than 0.25 in the bivariable analysis were
included in the multivariable logistic regression analysis
model. Variables with a p-value < 0.05 and AOR with a
95% Confidence Interval (CI) were considered statistically
significant.
Ethical considerations
The study protocol was approved by the Institutional Health
Research Ethical Review Committee of the College of
Health and Medical Sciences, Haramaya University
(IHRERC/092/2018). Official permission was obtained
from the East Hararghe zonal health office and Haramaya
district. Prior to the interview a signed, informed, and
voluntary consent was obtained from each participant. All
information collected from the study participants was kept
confidential and anonymous by omitting their personal
identifiers.
Results
Socio-demographic characteristics of participants
A total of 531 mother-child pairs participated in the study
with a response rate of 96%. More than half, 310 (58.4%)
of the children were in the age group of 12 to 23 months
and the median age of children was 12 months with an inter-
quartile range (IQR) of nine months (Q1 =9, Q3 =18). The
average monthly income of the family was less than $37.5
for 291(54.8%) participants (Table 1).
Reproductive and healthcare service utilization
About 429(80.8%) and 438(82.5%) of mothers were multi-
parous and multigravida, respectively. The majority,
398(75%) of the mothers received information about IYCF
practices, 345(87%) from healthcare workers, 32(8%) from
the health development army, and the remaining 21(5%)
were from various media. Four hundred thirty-four (81.7%)
mothers had breastfed their children in the last 24 h prior
to the interview (Table 2).
Complementary feeding practices
The percentage of mothers who practiced optimal comple-
mentary feeding was 53.5% (95% CI; 49.2%, 57.6%). A
total of 430(81%) children started complementary feeding
at six months of age. The majority, 472(88.9%) and
386(72.7%) of children had recommended MMF and
Ebroshe et al. 3
acceptable MDD standards respectively in the last 24-hours
before the interview.
Factors associated with complementary feeding
practices
A family with an average monthly income of $37.5 to $75
was 48% less likely (AOR =0.52, 95% CI: 0.28, 0.98) to
practices optimal complementary feeding compared to fam-
ilies with a higher income at $75 per month. Mothers who
gave birth in health care facilities were 1.61 times (AOR =
1.61, 95% CI: 1.06, 2.46) more likely to practice optimal
complementary feeding than mothers who gave birth at
home. Mothers who have attended postnatal care were
2.5 times (AOR =2.53, 95%:1.67, 3.82) more likely to
optimally nourish their children. Mothers who had an
awarness about IYCF practices were twice (AOR =3.05,
95% CI: 1.85, 5.02) more likely topractices optimal com-
plementary feeding than those who did not have informa-
tion. Mothers who participated in the IYCF demonstration
were twice as likely (AOR =2.02, 95% CI: 1.33, 3.07) to
practices optimal complementary feeding compared to
those who did not. In addition, mothers who had access
to nearby healthcare services with in a distance of less
than 30 minutes foot walk were 2.6 times (AOR =2.61,
95% CI: 1.65, 4.09) more likely to practices optimal com-
plementary feeding. Having a separate child-feeding plate
increases the likelihood of optimal complementary
feeding practices by 75% (AOR =1.75, 95% CI: (1.16,
2.64) compared to the counterpart (Table 3).
Discussion
This study showed that the overall percentage of mothers
that practiced optimal complementary feeding was 53.5%
Table 2. Reproductive and health care service utilization of
mother-child pairs in rural Haramaya district, Eastern Ethiopia,
2018 (n =531).
Characteristic Frequency Percent
Parity ≤1 102 19.2
≥2 429 80.8
Gravidity ≤1 93 17.5
≥2 438 82.5
Age at first marriage (in
years)
≥18 361 68.0
<18 170 32.0
Age at first pregnancy (in
years)
≥20 269 50.7
<20 262 49.3
Pregnancy intention Planned 211 39.7
Unplanned 320 60.3
Birth interval (in years) >3 332 62.5
≤3 199 37.5
Antenatal care visit ≥4 times 137 25.8
<4 times 394 74.2
Delivery place Health
facility
358 67.5
Home 173 32.5
Postnatal care follow up ≥3 times 220 41.4
<3 times 311 58.6
Having an awarness about
IYCF practices
Yes 398 75.0
No 133 25.0
Attended IYCF
demonstration
Yes 328 61.8
No 203 38.2
Attending HDA meeting Yes 224 42.2
No 307 57.8
Time to reach nearby public
health facility on foot (in
minutes)
≤30 173 32.6
>30 358 67.4
Note: HDA, Health Development Army; IYCF, Infant and Young Child
Feeding.
Table 1. Socio-demographic characteristics of mother-child pairs
in rural Haramaya district, Eastern Ethiopia, 2018 (n =531).
Characteristic Frequency Percent
Age of the child (in
months)
12–23 310 58.4
9–11 110 20.7
6–8 111 20.9
Sex of household’s head Male 476 89.6
Female 55 10.4
Age of mother (in years) <20 25 4.7
20–34 448 84.4
>34 58 10.9
Marital status Married 494 93.0
Others
a
37 7.0
Religion Muslim 524 98.7
Orthodox 7 1.3
Ethnicity Oromo 529 99.6
Amhara 2 0.4
Main occupation
(mother)
Housewife 489 92.1
Employee 12 2.3
Merchant 24 4.5
Main occupation
(father)
Farmer 473 89.1
Employee 21 4.0
Merchant 33 6.2
Others
b
4 8.0
Maternal education level Secondary and
above
15 2.8
Primary
education
152 28.6
No formal
education
364 68.5
Paternal education level Secondary and
above
29 5.5
Primary
education
179 33.7
No formal
education
323 60.8
Average monthly
income of family
<$37.5 291 54.8
$37.5 to $75 165 31.0
>$75 75 14.1
Decision making
autonomy of mother
High 212 39.9
Medium 77 14.5
Low 242 45.6
Note:
a
single, divorced, or widowed;
b
daily laborers, unemployed; $, United
States of America Dollar.
4Nutrition and Health 0(0)
(95% CI; 49.2%, 57.6%). This is in line with the study from
the Lasta district of Amhara region, Ethiopia 56.6% (Molla
et al., 2017). However, the current finding is much higher
than the results obtained in different parts of Ethiopia
like; Gombora district, 13.5% (Chaimiso et al., 2017),
Abiyadi town, 10.75% (Mekbib et al., 2014), Arsi
Negelle district, 9.5% (Kassa et al., 2016), and Northern
Ghana, 14.3% (Saaka et al., 2016), Nepal, 15.82%
(Chapagain, 2013), India, 20% (Kuriyan and Kurpad,
2012), and Haiti, 30.5% (Heidkamp et al., 2015). The var-
iation across the studies could be attributed to the differ-
ences in the timing of complementary feeding initiation,
the study setting, and participation in the IYCF demonstra-
tion (Saaka et al., 2016). Sub-optimal complementary
feeding practices have a deleterious effect on a child’s
growth, health, and development in the first two years of
life. So, strengthening the IYCF program is very important
to halt the effect of suboptimal complementary feeding
practices (UNICEF-WHO, 2020).
The family with a mean monthly income of $37.5 to $75
was less likely to practices optimal complementary feeding
than the family with a monthly income of more than $75 per
month. This finding is consistent with previous studies
(Abera, 2012, Gessese et al., 2014, Kabir et al., 2012).
This may be due to the fact that families with a low
income mightnot afford the food items to provide comple-
mentary feeding for their children. Therefore, efforts must
be made by the government and other stakeholders to
address poverty in this district in particular and at the
country level in general.
Mothers who gave birth in a health facility were more
likely to practice optimal complementary feeding than
those who gave birth at home. This is consistent with the
results of studies conducted in Ethiopia (Abera, 2012,
Demilew et al., 2017), and Kenya (Kimani-Murage et al.,
2011). Mothers who gave birth in health care settings
may havecontacts with healthcare providers who can
provide advice on appropriate child feeding practices
Table 3. Factors associated with complementary feeding practices among mother-child pairs in rural Haramaya district, Eastern
Ethiopia, 2018 (n =531).
Characteristic
Complementary
feeding practices
COR(95% CI) AOR (95% CI)Optimal Sub-optimal
Sex of child Female 130 97 1.31(0.92, 1.85) 1.44(0.93,2.21)
Male 154 150 1.00 1.00
Age of child (in months) 12–23 158 152 0.63(0.41,0.98) 0.78(0.45,1.34)
9–11 57 53 0.66(0.38,1.12) 0.58(0.31,1.0)
6–8 69 42 1.00 1.00
Maternal education Secondary 11 4 2.78(0.87,8.89) 1.63(0.41,6.4)
Primary 92 60 1.55(1.06,2.28) 1.55(0.97,2.4)
No formal education 181 183 1.00 0.78(0.45,1.3)
Average monthly income of family <$37.5 140 151 0.59(0.35,0.98) 0.94(0.50, 1.78)
$37.5-$75 98 67 0.92(0.53, 1.61) 0.52(0.28, 0.98)
>$75 46 29 1.00 1.00
Parity Primiparous 60 42 1.31(0.84, 2.03) 0.81(0.47,1.39)
Multiparous 224 205 1.00 1.00
Decision making autonomy High 138 74 2.17(1.48, 3.16) 0.91(0.51,1.62)
Medium 34 43 0.92 (0.55, 3.16) 0.74(0.39,1.42)
Poor 112 130 1.00 1.00
Pregnancy intention Planned 125 86 1.47(1.04, 2.09) 1.09(0.67,1.82)
Unplanned 159 161 1.00 1.00
Antenatal care visit ≥4 81 56 1.36(0.92, 2.02) 0.82(6.47,1.45)
<4 203 191 1.00 1.00
Delivery place Health facility 203 149 1.65(1.15,2.37) 1.61(1.06, 2.46)
Home 81 98 1.00 1.00
Postnatal care follow up ≥3 146 74 2.47(1.73,3.54) 2.53(1.67,3.82)
<3 138 173 1.00 1.00
Having an awarness aboutIYCF practices Yes 246 152 4.05(2.64,6.20) 3.05(1.85,5.02)
No 38 95 1.00 1.00
Attend IYCF demonstration Yes 178 150 1.55(1.09,2.21) 2.02(1.33, 3.07)
No 88 115 1.00 1.00
Time to reach nearby health facility on foot ≤30 minutes 115 58 2.22 (1.52,3.24) 2.61(1.65, 4.09)
>30 minutes 169 189 1.00 1.00
Separate child’s feeding plate Yes 154 91 2.03(1.43,2.88) 1.75(1.16, 2.64)
No 130 156 1.00 1.00
Ebroshe et al. 5
(Issaka et al., 2015). We recommend that health care
workers continue their efforts to educate mothers about
the optimal complementary feeding practice during the
antenatal care visit.
The current study delineates mothers who had postnatal
care visits were more likely to practice optimal complemen-
tary feeding than their counterparts. This finding is in line
with the studies from Bahirdar, Northern Ethiopia
(Demilew et al., 2017), Lasta district, Northeast Ethiopia
(Molla et al., 2017), Benishangul-gumuz region, Western
Ethiopia (Ayana et al., 2017), Gombora district, Southern
Ethiopia (Chaimiso et al., 2017), and Abiyadi, Northern
Ethiopia (Mekbib et al., 2014). Moreover, education may
improve adherence to infant’s feeding recommendations
and reduce the incidence of malnutrition in early childhood
which should be strengthened (Vaahtera et al., 2001).
Mothers who were aware of IYCF practices were more
likely to provide their infants with optimal complementary
foods than mothers who were unaware. This finding is in
accordance with the study done at Gombora district,
Southern Ethiopia (Chaimiso et al., 2017), Ghana (Saaka
et al., 2016), Nepal (Khanal et al., 2013), and Nigeria
(Sholeye et al., 2016). Similarly, the large-scale social,
behavioral change, and communication intervention study
from southern and Northern Ethiopia found that home
visits conducted by community volunteers and recall of
key messages were associated with a higher likelihood of
optimal complementary feeding practices (Kim et al.,
2016). Therefore, the health extension workers could play
a vital role in educating the community to prevent and
treat child malnutrition.
Mothers who participated in the IYCF demonstration
were more likely to apply optimal complementary feeding
practices than those who did not participate in the demon-
stration. This is similar to the study conducted in Debre
Markos, Northwest Ethiopia, where mothers who received
health education on the child feeding practices showed
better practices of optimal complementary feeding (Dagne
et al., 2019). Similarly, the study result from rural
Uganda, suggested an education on IYCF practices
improves optimal complementary feeding (Ickes et al.,
2017). Therefore, IYCF demonstration can be an effective
method for optimal complementary feeding practices, and
it has to be intensified.
This study showed that accessibility to nearby health
facilities is linked with optimal complementary feeding
practice. Similarly, Ogbo et al. (2015) found that mothers
who reported repeated contact with health service providers
were more likely to practices optimal complementary
feeding (Ogbo et al., 2015). This could be associated with
the fact that access to health facilities offers mothers the
best opportunity to receive information from health care
workers about optimal complementary feeding (Abeshu
et al., 2016).
Our study indicates that the separate feeding bowl for the
child is related to best practice for optimal complementary
feeding. Similarly, the study result from Sri Lanka
demonstrated that mothers who have separate feeding
plates for their children have better complementary
feeding practices (Dharmasoma et al., 2020). The safe pre-
paration and storage of complementary foods can prevent
contamination and reduce the risk of diarrheal diseases,
which has a major impact on children’s diet and health
(WHO, 2009).
In general, the outcome of this study, along with other
pocket studies from different corners of Ethiopia, can
serve as input for national-level nutrition programs.
However, the study might have had some limitations,
such as recall bias among the participants.
Conclusion and recommendation
Almost more than half of the mothers provide optimal com-
plementary feeding for their babies. It is associated with
economic status, access to and use of health services,
awareness, and ability to prepare optimal complementary
foods. We recommend the mothers to provide a separate
feeding plate for their child and participate in IYCF demon-
strations conducted at their living village. Health profes-
sionals have to encourage mothers to seek postnatal care
follow-ups and advise on optimal complementary feeding
practices during the visit. The health policymakers should
give due emphasis to the use of health care services and sen-
sitization of the community for optimal complementary
feeding for infants and children. In addition, we recommend
the future researchers to address the socio-cultural barriers
and facilitators of optimal complemetary feeding practice
with a qualitative study method.
Abbreviations
IYCF Infant and Young Child Feeding
MMF Minimum Meal Frequency
MDD Minimum Dietary Diversity
WHO World Health Organization
Acknowledgements
We are grateful to the study participants, data collectors, and
field supervisors for their unreserved contribution to this study.
Also, we would like to thank Haramaya University for funding
this study.
Author’s contribution
All authors made an equally significant contribution to the present
work: conception, study design, implementation, and collection of
data, analysis and interpretation. Likewise, they participated
equally in the creation and critical review of the work. They
have mutually agreed on the journal to which the article was sub-
mitted for publication. Ultimately, they agreed to share equally the
responsibility of accounting for all aspects of the work and submit-
ting the final approved version for publication.
6Nutrition and Health 0(0)
ORCID iDs
Hassen Abdi Adem https://orcid.org/0000-0003-0582-4861
Gelana Fekadu https://orcid.org/0000-0001-5409-4979
Data availability
The datasets used for analysis are available from the correspond-
ing author upon reasonable request.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
Haramaya University financially supported this study. We declare
that the funding agency has no role in the design of the study, in
the collection, analysis, and interpretation of the data, in the pre-
paration of this manuscript, and in the decision to submit it for
publication.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
This work was supported by the Haramaya University, (grant
number IHRERC/092/2018).
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