A minimum acceptable diet (MAD) is a measure of the quality and quantity of complementary feeding for children aged 6–23 months. It is based on the combination of dietary diversity and meal frequency. Conducting a study on MAD can help to assess the nutritional status and feeding practices of young children, identify the factors that influence their diet, and design interventions to improve their health and development. This study aimed to assess the knowledge and attitude of mothers on complementary feeding among children aged 6–23 months and the factors influencing adequate diet in Tulla District, Sidama Region, Ethiopia.
The results of this research showed that only 14.5% (95% CI: 12.02%-19%) of the children aged 6–23 months who were enrolled in the outpatient therapeutic program met the minimum adequate diet criteria. This suggests that the complementary feeding practices in the study area were inadequate and could lead to growth problems. Therefore, it is important to implement effective interventions to improve the nutritional status of these children. The quality and quantity of food that a child receives in the first years of life can have a lasting impact on their health and development. Feeding practices that are unsuitable or inadequate can increase the child's vulnerability to malnutrition, vitamin deficiencies, diarrhea, and respiratory tract infections. On the other hand, feeding the child with appropriate and sufficient food can enhance their mental and motor development, reduce their risk of obesity, protect them from various infectious diseases and their mortality, and improve their overall development(29–31). This fnding higher than studies conducted in Tigray (2.30%)(32), North West, Ethiopia (12.6%)(1), EDHS 2016( 6.10%)(33), Uganda (5.34%) (34), India(8·4%)(35), Dembecha (8.60%)(22). However, lower than the studies conducted in Addis Abeba(76.6%)(21), Mareka District(35.5%)(23), Bangladish (38%)(36), Lalibela, northeast Ethiopia(16.7%)(37), Myanmar (16.00%)(38), Delhi (19.70%)(39), Congo(33%)(40), central Amhara (31.60%)(41), Kaski (42.40%)(42), Abu Dhabi(36.20%) (43), Ghana (24.90%)(43), Rural Madagascar (50%) (44), and Bangladesh (23.00%)(45). The fact that the study contexts, economic backgrounds, and data collection seasons varied could be one reason for discpancy in the finding. Furthermore, variations in study methodology, sample size, study period, and sociodemographic variation may account for the level discrepancies between the finding.
Our study shows that most mothers((76%) knew the right time to start giving other foods besides breast milk, but majority of mothers (64.7%) did not explain why they should do so at six months. It also shows that less than half of the mothers (37.9%) knew how to make the food more nutritious and varied. These knowledge gaps could be dangerous because they could lead to early or late introduction of complementary foods, which could affect the child's growth and development negatively. Therefore, this suggests that health workers should give more counseling and education on nutrition during the regular sessions of growth monitoring and child care events.
We assessed the mothers' attitudes toward feeding habits for infants and young children in this study, as these practices are critical to the growth and development of children. While most women (85%) believe that feeding their children multiple times a day is good, over 40.2% of them said they found it challenging to feed their children multiple times a day. While the majority of women feel comfortable making meals for their children, nearly half of them said they had trouble doing it. These challenges may have contributed to the low degree of meal frequency and dietary diversity that we found in our study, which may have had detrimental effects on the children's health and nutritional status. The mothers' low income may be a contributing factor in these issues since it may restrict their access to a variety of wholesome foods. In reality, the majority of the mothers claimed that their inability to provide their kids with a variety of meals at the suggested times was due to their lack of income. The economic barriers that mothers face should also be addressed by interventions aimed at improving infant and young child feeding practices. Healthcare providers should also offer individualized counseling to mothers and other caregivers during child health care sessions to help them identify the unique obstacles they face in adhering to the recommendations for infant and young child feeding. Mothers and other caregivers may receive encouragement to implement the best feeding habits during these sessions, as well as support in overcoming some of the challenges they encounter. This technique will promote children's growth and health as well as the amount and quality of feeding practices for infants and early children.
In this study, several factors were identified that affected minimum adequate diet among 6–23 months old children who admitted to outpatient therapeutic program in the study area. Mothers who did not have formal education, mothers whose knowlege level greater than seventiy perecent and children who were aged 18–23 months were significantly associated factors with minimum adequate diet.
Mother education was significantly associated with the minimum acceptable diet practice. Based on this study, mothers who had no formal education were 81% less likely to provide minimum acceptable diets for their children compared to mothers who had no formal education. This finding was supported by studies done in Dembecha and Goncha districts, northwest Ethiopia, respectively(1, 22). These studies reported that mothers who had formal education were more likely to provide the minimum acceptable diet for their children compared to mothers who had no formal education. This could indicate that education helps mothers understand the advantages of child feeding practices and contributes to achieving a minimum acceptable diet.
Our study showed that th e odds of an adequate diet were 1.9 times higher among children who were aged 18–23 months compared to children who were aged 6–11 months (AOR = 1.9, 95% CI (1.2 to 3.9). This finding was supported by a previous study that was conducted in Debre Berhan Town, Ethiopia(41). It is likely that mothers' perceptions of their young children's stomachs being incapable of breaking down solid or semisolid food are the cause of the correlation between greater probabilities of MAD and advancing age. As a result, after the infant turns 12 months old, the mother may start introducing a varied solid and semisolid diet instead of just a milk-based one.
A minimum adequate diet is essential for the growth and development of children. It means that the children receive a variety of foods from different food groups and that they meet the minimum requirements for frequency and quantity of feeding. One factor that influences this diet is the mother's knowledge of infant and young child feeding recommendations. These are guidelines that provide information on what, when, and how to feed infants and young children.This study showed that children whose mothers had a good knowledge of these recommendations were 2.9 times more likely to have a minimum adequate diet than those whose mothers did not. This result is consistent with a previous study in Ghana(25), which also found a positive association between a mother's knowledge and a child's diet. The reason for this may be that mothers who are well-informed about infant and young child feeding recommendations try to ensure and provide a minimum adequate diet for their children.