Stunting, a sub-form of malnutrition, which is responsible for 14% of global childhood deaths also heavily debilitates cognitive growth and physical capabilities, leaving the future of a person less gainful than it would otherwise have been [1, 2]. There are a wide number of risk factors for stunting and one that is most often corroborated by studies is complementary feeding practices [2, 3]. In many countries across the world, few children receive nutritionally adequate and safe complementary foods; and less than a quarter of the population of infants 6–23 months of age meet the criteria of the Minimum Acceptable Diet (MAD) appropriate for their age . These reports of inappropriate and inadequate complementary feeding practices feed into the current 21.9% of stunted children that are in the world .
In Uganda, Infant and Young Child Feeding (IYCF) and thus complementary feeding is guided by the Policy Guidelines on Infant and Young Child Feeding. The recommendations from discussions at several technical consultations and documents on complementary feeding produced by the World Health Organisation and UNICEF were used to develop the guidelines. The guidelines described complementary feeding as providing other foods (solid or semi-solid) to the infant, in addition to breastfeeding or replacement feeding, to fulfil the nutritional needs of the baby from the age of 6 months . Herein replacement feeding referred to feeding a child not receiving breast milk on a sufficient diet until a time when the child is fully fed on family foods . The guidelines further elaborated on the practices by recommending: introduction of complementary foods at the age of 6 months; continued breastfeeding until 2 years of age and beyond; feeding on various nutritious, locally available foods; feed liquid/soft, semi-solid foods using clean cups and spoons; disuse of cups with spouts, bottles or teats; preparing food with the right consistency (thickness) and nutrient density (especially energy and micronutrients); feeding as frequently as is consistent with the child’s age; practising active feeding; practising high standards of hygiene when handling the child’s food; feeding the child more frequently when sick with extra fluids; and maintaining sanitation and food/water safety [6, 7].
However, several studies have reported on the inadequacy in IYCF practices and consequently complementary feeding practices and advocate for the need to support populations, especially in low- and middle-income countries such as Uganda to adopt the recommended evidence-based guidelines when practising complementary feeding. These studies established that when complementary feeding practices were carried out appropriately per the global and national recommendations, then they were termed as appropriate or optimal but when they were inadequate, they were considered inappropriate or sub-optimal with terrible consequences to a child’s growth and future productivity [1, 5, 8–11].
Several studies revealed that proportions of children meeting requirements for optimal complementary feeding (CF) were generally low with minimum acceptable diet (MAD), minimum dietary diversity (MDD) and minimum meal frequency (MMF) in order of lowest to slightly higher across all the regions. Other indicators such as continued breastfeeding (CBF) at 1 year and introduction of solid semi-solid or soft foods (ISSSFs) showed higher proportions for children aged 6–23 months [5, 12–14]. The literature also revealed the prevalence of MDD in Kisoro district to be very low at 3.9% . The prevalence of the other CF indicators was not revealed, however.
Various factors were documented to be associated with complementary feeding and this study concentrated on factors according to the SEM, at the settings, interpersonal and intrapersonal levels.
At the settings level, the literature explored locations or social contexts that were positively or negatively associated with complementary feeding practices (CFPs); the factors mentioned were the type of occupation of the caregiver [16–19]; rural vs urban areas [20–24]; ease of access to a health facility [25, 26]; type of community group [15, 27–29] and place of delivery [25, 30–32]. At the interpersonal level, the literature delved into relationships and household factors documented to be associated with CFPs which included family or household size [22, 23, 33, 34]; the number of children under five years of age [16, 35–37]; the number of household chores (workload effect) [22, 38–40]; the influence of interpersonal relationships with emphasis on the marriage partner (marital status) [16, 22, 30, 35, 41–44]; WASH situation of the household [16, 45, 46] and household wealth [16, 17, 20, 22, 24, 26, 34, 43, 47]. At the intrapersonal level, the literature examined biological characteristics and personal background factors of caregivers recognised as associated with CFPs which included the age of the caregiver [16, 17, 24, 43]; the education level of the caregiver [16, 17, 19, 25, 43, 48]; antenatal and postnatal visits [21, 25, 33, 34, 47, 49]; sex of the HH head [22, 34, 40]; age and sex of the child [17, 22, 43, 48, 50, 51]; and maternal parity [33, 42, 43].
However, to the best of our knowledge, none of the studies determined the prevalence of more than three OCFPs and the factors that lend to caregivers meeting requirements for the optimal complementary feeding practices in the Kisoro district. Cognizant of this empirical gap, this study, therefore, sought to determine the prevalence and factors associated with the optimal complementary feeding practices of caregivers and their children aged 6–23 months in Kisoro district. The findings gathered from this study will provide evidence for use by policymakers and organisations towards strengthening existing strategies tackling the malnutrition scourge, at least in the Kigezi region.