Factors associated with complementary feeding practices among children aged 6 – 23 months in Pader District

Abstract

Introduction: Infant and young child feeding has been known to compromise the health of children among which complementary feeding plays a major part. Even communities that have performed adequately in breast feeding have had their efforts undermined by complementary feeding practices so factors influencing these practices should be studied in order to address the issue and prevent malnutrition among children. This study was conducted with the aim of finding out maternal, child and environmental factors that are associated with complementary feeding among the children in Pader district. Methods: A cross sectional study that employed both qualitative and quantitative data collection methodologies was used. The quantitative study used a two-stage cluster sampling procedure involving 270 households and data was collected through use of an interviewer administered structured questionnaire. The qualitative study comprised of 3 focus group discussions with mothers and fathers of children aged between 6 and 23 months. Complementary feeding was defined using indicators of dietary diversity,meal frequency and timeliness. Factors associated with these indicators were grouped into maternal, environmental and child related factors. Bivariate and multivariate analysis was done to determine associations between the outcome variable and the independent variables. Results: 63% of the mothers who participated in the study were less than 30 years and 55% had at least attained a primary education. Most of the mothers (87%) were married, 52% had a parity of 1-3 children and 77% practiced subsistence farming as their main occupation. The percentage ofchildren aged 6-8 months and 9-23 months who attained the recommended meal frequency was 71% and 57% respectively. A small proportion (32%) of the children received the recommended dietary diversity of 4 food groups. Almost all children (99%) aged 6-8 months were on complementary feeding i.e. had started eating solid, semi-solid or soft foods.

Factors associated with minimum meal frequency were: child’s age (older children i.e. 9-23 months were 0.5 times less likely to meet the MMF as compared to younger children 6-8 months – OR = 0.57 CI = 0.33 – 0.99), parity (mothers of high parity i.e. more than 6 children were 3 times more likely to meet MMF than those with low parity of 1-3 children – OR = 3.29 CI = 1.38 – 7.96) and child’s appetite (children with good appetite were 4 times more likely to meet the MMF than those with a fair appetite – OR = 4.29 CI = 1.84 – 9.96).

Factors associated with recommended dietary diversity were occupation (children whose mothers practiced subsistence farming were 0.5 times less likely to meet RDD than those whose mothers were employed OR = 0.49 CI = 0.24 – 0.99), main source of income (households whose main source of income was sell of surplus agricultural products were 2 times more likely meet RDD than those whose source of income was mother’s employment OR = 1.84 CI = 1.00 3.35), appetite (children with a fair appetite were 6 times more likely to meet the RDD than those with a poor appetite OR = 6.43 CI = 1.84 – 22.50), food (households with access to food were 2 times more likely to meet RDD than those with no access to food OR = 1.72 CI = 1.03 2.89) and water availability (households with access to water were 0.5 times less likely to meet RDD than those with no access to water OR = 0.55 CI = 0.31 – 0.97).

There was no association between timeliness and the independent variables (OR = 1). Conclusion: Complementary feeding among children as assessed by dietary diversity was poor though meal frequency and timely introduction of complementary food scored well. Complementary feeding scored better amongst mothers who were employed and with more children as well as amongst younger children (6-8 months) and those with good appetite feed adequately. Households that practice subsistence farming, those with adequate food and unavailable water are in better position to feed children adequately. Recommendations: dietary diversity can be improved by improving maternal economic status through creation of income generating activities and encouraging better farming methods to improve subsistence farming. Infant and young child feeding sensitizations are required to boost mothers’ knowledge on child feeding and strategies can be developed to help parents whose children have poor appetite to consume more meals.