Minimum acceptable diet and associated factors among children aged 6–23 months in Ethiopia

Improving nutrition through appropriate complementary feeding practices is crucial for the achievement of healthy growth, development, and survival of young children and is one of the most cost-effective approaches to address many of the societal, environmental, and economic challenges worldwide [1‐3]. The World Health Organization (WHO) recommends the indicators of proper complementary feeding as starting solid, semi-solid, or soft foods, minimum meal frequency, minimum dietary diversity, minimum acceptable diet, and consumption of iron-rich or iron-fortified foods [4].

Insufficient quantities and inadequate quality of complementary foods, poor child feeding practices, and high rates of infections harm health and growth in children less than 2 years of age [5]. Any damage caused by nutritional deficiencies during the first two years of life can lead to impaired cognitive development, compromised educational achievement, and low economic productivity [6].

Globally, ensuring optimal complementary feeding can avert a substantial proportion of childhood deaths [5]. Worldwide, poor Infant and Young Child Feeding practices have been identified as significant contributors to under-nutrition. South Asia is the hardest hit of childhood under-nutrition worldwide [7, 8]. Sub-Saharan African countries carry the highest risk of this global burden. In Ethiopia, only 8% of infants aged 6–23 months receive complementary foods while continuing to be breastfed [9]. According to the National demographic health survey of Ethiopia (EDHS) 2016, the prevalence of minimum dietary diversity (MDD), meal frequency, and minimum acceptable diet (MAD) was 14, 45, and 7% respectively [9]. Several studies in Ethiopia showed that the minimum acceptable diet in children whose age between 6 and 23 months was 8.6% in Dembecha, 6.1% in other parts of Ethiopia, 8.8% in two agro-ecological zones of rural Ethiopia, 21.1% in Wolaita Sodo, and 8.4% in Gorche District [10‐14]. Similar studies in Addis Ababa also revealed that the prevalence of minimum meal frequency (MMF), MDD, and MAD was 67.4, 43.4, and 27.1% respectively [9].

In many low-income countries including Ethiopia, meeting MDD and MMF standards has been a serious challenge, especially in areas where household food security is poor [15]. Culture affects the practice of dietary diversity, meal frequency, and minimum acceptable diet [16]. Despite increased attention to undernutrition; nutritional deficiencies remain a multifaceted problem affecting infants, young children, adolescent girls and women. Information on dietary diversity, meal frequency minimum acceptable diet, and associated factors are needed to prioritize, design and initiate further intervention programs aimed at improving dietary diversity and meal frequency to reduce under nutrition in children [17].

In Ethiopia, considerable progress has been made in the development of complementary feeding and the provision of national nutrition programs by defining standards for appropriate feeding through the notable publication of different guiding principles. However, the strategies for breaking the inter-generational cycle of malnutrition were not well focused and not complete, particularly in addressing the critical window of opportunities “the first 1000 days” and critical elements of efforts such as encouraging and supporting appropriate complementary feeding for children aged 6–23 months [18].

Empirical evidence on minimally acceptable diet and associated factors are limited in Ethiopia and they are in the rural communities and district level [13]. Therefore, this study was aimed to assess the prevalence of a minimum acceptable diet and its associated factors among children aged 6–23 months in the capital city of Ethiopia. So, the findings of this study will help the Ministry of health and its partners who are working on nutrition-related activities to prioritize the problem design and initiate further intervention programs.

Achieving a minimum acceptable diet among infants and young children of 6–23 months of age is one of the strategies currently used to break the intergenerational cycle of malnutrition. The study findings showed that the proportion of children who received minimum dietary diversity is higher than studies conducted in Addis Ababa (59.9%) [28], Dembecha, North West Ethiopia (9.8%) [10], Gorche District, southern Ethiopia (10.6%) [14]. The difference might be due to the difference in the study area, study period, and educational status of the mothers.

Similarly, the minimum meal frequency of the study was higher than that reported in studies coducted in Ethiopia such as Dabat District (72.2%), Dangla Town (50.4%) and Wolaita Sodo town (68.9%) [13, 15, 29] but it is lower than the study done in Filipino (93.5%) [30]. This discrepancy might be due to the difference in the study setting by which this study was conducted in urban residents and other possibilities might be due to the presence of low attention for child feeding in the previous year and low practice of health care utilization.

In this study much amount of the children who received minimum acceptable diet, which is much higher than findings in Dembecha, North West Ethiopia, Wolaita Sodo town, Northern Shoa (Oromia region), and EDHS 2016 [9, 10, 15, 28, 31]. This is because of the difference in the study period and setting; this study was done in the capital city of Ethiopia (urban setting) and is an institution based which makes the mothers have better educational status and increased awareness to access health service and information on child feeding practice. Other possibilities might be due to an increment of different inter-sectorial and nutritional collaborative programs.

In this study, we have found some factors associated with a minimally acceptable diet. These included; educational status of the father, maternal occupation; history of postnatal care visit, gender, maternal age, and age of the child. Mothers who had a history of more than three postnatal care visits were two times more likely to provide the recommended minimum acceptable diet than their counterparts. This finding is supported by a study done in Northern Shoa, Ethiopia [31]. This is because those mothers who had postnatal care follow-up might have better nutritional advice and counseling provided by health workers during post-natal care visits.

Those children with the age group of 18–23 months had higher odds of having a minimum acceptable diet than those children whose ages were 6–11 months old. This finding is supported by a study done in Afghanistan, rural Ghana, Wolaita Sodo, EDHS 2016 [11, 13, 32, 33]. This might be because mothers may perceive the young child as having the poor ability of the intestine to digest certain foods and the late introduction of complementary feeding might cause the poor feeding interest of the child.

Children born from fathers who had a secondary and above level of education were four times more likely to meet the recommended minimum acceptable diet than those fathers who have no formal education. This study is supported by EDHS, 2016 [33]. This might be because educated fathers were more likely to have information (media exposure) and better understanding for messages and any information about child feeding easily practice.

Children born from mothers who were government employees were 64.9% more likely to receive a minimum acceptable diet than housewives. This finding is in line with EDHS, 2016 [33]. But it is contrary to a study done in Filipino [34]. This might because employed mothers are usually educated and had increased access to the resource, information, and understanding of their social environment than unemployed mothers (housewives).

children who were born from mothers whose ages were in between 25 and 34 years were two times more likely to practice the recommended minimum acceptable diet than the age group of 15–24 years. This finding was similar to a study done in Dabat District, North West Ethiopia [29]. This might be because mothers in this age group are highly productive and had better potential to take care of and feed their children properly.

Finally, male children were more likely to achieve the minimum acceptable diet than female children. The finding was supported with the study done in Ethiopian adolescents [35], West Guji Zone, Oromia, Ethiopia [36] and Sodo zuria District [37]. This might be due to the culture and or traditional perceptions in Ethiopia mostly give high priority to the male baby than females.

In this study, the practice of minimum acceptable diet in children aged between 6 to 23 months is relatively high in Addis Ababa. Being 18–23 months old child fathers educational level of secondary and above, having more than three postnatal care visits, being a housewife, being male gender, and maternal age between 25 and 34 years were some of the factors associated with the practice of minimum acceptable diet. More efforts should be needed to educate and advocate the benefit of the feeding of recommended minimum acceptable diet for all children to break the intergenerational cycle of malnutrition. On the other hand, it is important FMOH encourage postnatal care service utilization and health professionals who give postnatal care service should also provide education and counseling on the benefit of the feeding of the recommended minimum meal frequency and meal diversity to the child, advise the mother to avoid traditional believes that inhibit the practice of child feeding. Additionally, it is important to do on the gender equality of feeding practice of the mother. A strong study design (cohort) should be recommended.