Adequate nutrition during infancy and early childhood is fundamental to the development of each child’s full human potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development (1).The immediate consequences of poor nutrition during these formative years include significant morbidity and mortality and delayed mental and motor development. In the long-term, early nutritional deficits are linked to impairments in intellectual performance, work capacity, reproductive outcomes and overall health during adolescence and adulthood (2).For this reason, it is essential to ensure that caregivers are provided with appropriate guidance regarding optimal complementary feeding of infants.
Complementary feeding is defined as starting food and water when breast milk alone is no longer sufficient to meet the nutritional requirements of infants and therefore other foods and liquids are needed, along with breast milk. The target age range for complementary feeding is generally taken to be 6 to 24 months of age, even though breastfeeding may continue beyond two years (3).
Following the World Health Organization (WHO) recommendations, timely introduction means that complementary feeding should be introduced at 6 months of age. Complementary feeding is needed from that age because breast milk or infant formula alone are not enough to cover the infant’s energy needs or provide sufficient amounts of certain nutrients such as protein, zinc, iron and fat-soluble vitamins (4).
Infants are born with a store of iron in their liver that is sufficient for the first 6 months of life but after that the amount of iron in breast milk will not satisfy infants’ nutritional requirements for iron (5). In addition to timely introduction, the WHO also emphasizes diet diversity, meaning that a variety of the basic food groups should be included as part of the complementary feeding to ensure a heterogeneous nutrient intake that satisfies all nutrient needs in the growing infant (6).
The need of infants for energy and nutrients start to exceed what is provided by breast milk at the age of 6 months and complementary foods are necessary to meet those needs. Most of the times there are problems related to practicing complementary feeding for infants in most areas of the world. The problems are complementary foods are often provided to the infants of inadequate nutritional quality, or they are given too early or too late, or in too small amounts, or not frequently enough. If the feeds are given inappropriately, the growth of the infant may be faltered (7). In many developing countries, the incidence of under-nutrition usually increases during the period of complementary feeding from the age of 6 to 18 months (7). The occurrence of early nutritional deficits is linked to long-term impairments in child growth and health (7).
According to the 2019 mini Demographic and Health Survey (mEDHS), the Ethiopian national prevalence of appropriate complementary feeding practices among infants was 41% (8). Contrary to the WHO recommendation that children under the age of 6 months should not start complementary feeding, 14% of infants 0–5 months consume plain water, 1% of infants consume non-milk liquids, 8% consume milk, and 9% of infants under 6 months use a bottle with a nipple, a practice that is discouraged because of the risk of exposing the child to illness (8). However, the regional variation (among the regions of Ethiopia) of complementary feeding practice was not separately addressed by the Ethiopian Mini Demographic and Health Survey, 2019 (8). The mini EDHS also revealed that, 37.2% of infants in Ethiopia meet the criteria of dietary diversity and feeding frequency that are appropriate for their age. Thus, only few children receive nutritionally adequate and safe complementary food (8).
Inappropriate complementary feeding practice may result in malnutrition and cause various diseases. Almost half (45%) of all children’s deaths are associated with malnutrition, while children in sub-Saharan Africa are more than 14 times likely to die before the age of 5 than children in developed regions (9).
Until now, indicators used to measure infant and young child feeding practices in population-based surveys have focused mostly on breastfeeding practices (10). Considerations were not given to quantity and quality of complementary foods and feeding practices including dietary diversity like breast feeding. Meanwhile, inadequate knowledge about appropriate foods and the feeding practices are often greater determinants of malnutrition than mere lack of food (11). Having a better complementary feeding knowledge and practices among mothers of infants will prevent the consequences of malnutrition thereby enabling children to receive appropriate nutrition and consequently achieve their full human potential (12).
Optimal complementary feeding practices depends not only for what is feed, but also on how, when, where and by whom the child is feed (9). In many developing countries, less than 25% of infants within the age 6–24 months meet the criteria of dietary diversity and feeding frequency that are appropriate for their age (13). Thus, only few children receive nutritionally adequate and safe complementary food (14). In Ethiopia, according to the Demographic and Health Survey, more than 70% of infants are given complementary food too early which is usually of poor nutritional values (5). Study also shows that only 37.2% of infants receive nutritionally adequate and safe complementary food in Ethiopia though inappropriate complementary feeding practice may result in malnutrition and cause various diseases. (15).
Thus this study will assess the complementary feeding practices and associated factors for infants attending Hawasa University Comprehensive Specialized Hospital assessing the level of attainment of minimum acceptable diet, meal frequency and dietary diversity during complementary feeding of infants in addition to identifying factors affecting complementary feeding practices for infants.
Significance of the study
Acknowledging this, the interest in the complementary feeding practices and associated factors of infants is not incidental; rather it is influenced by a thorough observation and experience in the child health program. On top of this acknowledgement, finding of this study will also provide clear evidence of complementary feeding practices and associated factors for infants in the study areas to assist healthcare providers and managers to plan for further improvement of the program of infant’s complementary feeding practices.