Assessment of Complementary Feeding Practices and Associated Factors among Infants Aged from 6-24 months in Hargeisa, Republic of Somaliland: A Cross-Sectional Study in 2024"

doi:10.21203/rs.3.rs-4352402/v1

Background and Objectives: The weaning process from the breast milk to intake of other foods and drinks, during infancy is a very crucial stage whereby a child is vulnerable to malnourishment should proper feeding practices not be put into practice. This work was essentially important to assess the prevalence and associated factors of appropriate complementary feeding practice among infants aged from 6-24 months in Hargeisa, Republic of Somaliland 2024. .

Methods: A descriptive cross- sectional study was carried out among the primary health facilities in Hargeisa. The multistage sampling approach was very used and recruited 370 mother-and-child pairs. The data collection was done through the pre-tested interviewer administered questionnaire with the WHO infant and young children feeding indicators (IYCF) IBM SPSS version 23 was employed to go into and encode quantitative data. data was presented in descriptive statistics using tables and figures by computing the frequencies and percentages of Appropriate complementary feeding practices, Bivariate logistic regression analyses was done to identify candidate variables for adjusted regression at p-values of <0.05 and multivariable logistic regression were presented as p-value <0.05 with Adjusted Odds ratios (AOR) with 95% confidence intervals. All tests were two sided to determine statistical significance

Results: The analysis revealed that the overall prevalence of appropriate complementary feeding practices was 46%. While Unemployed mothers were more likely to practice ACFP compared to employed ones (AOR=3.5, 95% CI: 2.15-5.69, p<0.001). Larger families (≥5 members) exhibited higher adherence to ACFP (AOR=4.193, 95% CI: 2.650-6.634, p<0.001). Avoiding bottle feeding (AOR=2.907, 95% CI: 1.88-4.49, p<0.001), maintaining good WASH and hygiene status (AOR=4.488, 95% CI: 2.86-7.05, p<0.001), achieving adequate dietary diversity (AOR=0.032, 95% CI: 0.05-0.068, p<0.001), meeting the minimum acceptable diet (AOR=0.012, 95% CI: 0.005-0.027, p<0.001), and timely introduction of complementary foods at 6 months (AOR=2.504, 95% CI: 1.636-3.832, p<0.001) were all significantly associated with higher ACFP adherence. These findings underscore the importance of addressing socio-demographic and dietary factors to improve infant feeding practices in the community.

Conclusion and Global Health Implications: The research revealed that problematic complementary feeding practices were in the high cases. Measurement of composite indices showed a qualitative picture of these various practices and their components, understanding the diverse manifestations of complementary feeding. This information may be very indispensable to obtain targeted interventions aimed at improving the complementary feeding practices in this community.

Complementary feeding

maternal and child health

Somaliland

nutrition practices

infant feeding

public health.

Introduction of solid, semi-solid, or soft foods at the age of 6–8 months to child constitutes complementary feeding. This practice intends to satisfy the increasing energy and nutrient demands of the child. It will be quite a stretch until the child is in a position to consume a diet similar to the rest of the family (Mitchodigni, Amoussa Hounkpatin et al. 2017). The complementary feeding period is a key window of opportunity for the prevention of different types of malnutrition including wasting, stunting, obesity and overweight (White, Bégin et al. 2017). It is therefore due to the fact that at the age of 6 months breast milk alone is no longer able to provide all the needed nutrients and calories that such other foods are introduced to complement the nutrients and energy needs of the infant. Lack of complementary foods provided at the appropriate age or their inappropriate introduction may lead to the retardation of infant's growth(Abeshu, Lelisa et al. 2016, Olatona, Adenihun et al. 2017).

Complementary feeding is the addition of safe and appropriate foods to children aged six months and above, through which the child's diet is diversified to meet his/her changing nutritional needs and support growth, development, and overall well-being.(WHO 2008) This is a critical stage because it coincides with a period of heightened vulnerability in children which is characterized by many growth challenges, micronutrient deficiencies and an increased risk of diseases such as diarrhea and respiratory infections (Ndiokwelu, Maduforo et al. 2014)

Improved complementary feeding results to 6% mortality reduction However, in the developing world the complementary foods provided to infants and young children are often bad or not enough in quantity (WHO 2008). The Baby Friendly Initiative, the National Policy on Infant and Young Child Feeding and other such efforts have been introduced in Nigeria, but the level of practice of appropriate complementary feeding practices remains low, affecting less than 10% of children aged 6–23 months in the country (Health 2010, Nutrition 2013).

Globally, almost half to two-thirds of child deaths are associated with under-nutrition with one third of child fatality stemming from low complementary feeding and sub-optimal breastfeeding. Malnutrition is the 60 percent of the total 10.9 million annual deaths from children under five years of age worldwide. The majority of these deaths, more than two-thirds, occur within the first two years of life and are commonly linked with inappropriate complementary feeding practices and infection Every year, over 10 million children who are less than five years old die of different factors, and 41% of these deaths transpire in sub-Saharan Africa while an additional 34% transpires in South Asia. Immediately, poor breastfeeding and complementary feeding practices are identified as leading causes of these mortalities. It is estimated that by the end of the first 6 months of a sub-optimal complementary feeding leads to 1.4 million death and accounts for about 10% of the morbidity in children under the age of five (Alemu, Ahmed et al. 2017).

The proportion of infants and young children having proper feeding practices has been on a decrease in Nigeria; the percentage went down from 30% in 2008 to 10% in 2013. On 2018, overall, only 11% of the children aged 6-24 months received minimum acceptable diet as recommended which indicates need for persistent interventions to promote and implement appropriate infant feeding practices in the country(Commission 2013, Demographic 2019).

The rate of child malnutrition is very disconcerting at 50% in Somalia. A comprehensive studies' summary by FSNAU concludes a nationwide 24.9 percent national stunting mean. This means around 1.4 million kids become the victims and that is more than the whole population of San Diego, California. Some areas in Somaliland have challenges with 4.2% of the children suffering stunting and 9.8% experiencing wasting. A stunting prevalence exceeding 20% by the World Health Organization (WHO) becomes a major public health problem (Kinyoki, Berkley et al. 2016).

The literature has used the WHO IYCF indicators to study complementary feeding and the data has shown a low prevalence of appropriate feeding practices in various regions. In Nigeria, data spanning from 2003 to 2013 indicates a concerning trend: The minimum dietary diversity for children aged 6-23 months declined from 26% in 2003 to 16% in 2013, while the minimum meal frequency showed an improvement from 43% in 2003 to 56% in 2013. On the other hand, the incidence of minimum acceptable diets decreased somewhat from 11% to 9% the same period. Likewise, in the Northern Ghana, 58.2% met the minimum number of meals, 34.8% for the minimum diet variety, and 27.8% for the minimum acceptable diet. The situation in Cambodia was equally bad, as only 28% of children met the minimum dietary requirements. The rate of minimum dietary diversity among children in Southern Ethiopia was particularly low, with about 19% of them meeting this criterion (Kassa, Meshesha et al. 2016).

Study design, area and setting

The study site was a Hargeisa city local government Administration (LGA) in Republic of Somaliland. It was a descriptive cross-sectional design study targeted mothers or caregivers of children of age ranges 6-24 months attending immunization clinics at selected PHCs in the Hargeisa city LGA. Over 50% of the local government Administrations Primary Health Centers were selected, through a multistage sampling approach, for 370 mother- child pairs.

Study Variables

The dependent variables covered complementary feeding practices such as MDD, MMF and MAD. Covariance of the study included the mother’s level of education, income, place of work, marital status and household size. Independent variables referred to the socio-demographic characteristics of the children such as gender, age and so on. MDD, MMF, and MAD were delivered and calculated with the help of WHO definitions and seizure appropriate.

MMF denotes the percentage of children received complementary foods a minimum recommended count for the last 24 hours.

MDD was being calculated by recalling information of foods consumed in amount equal to four or more varieties out of seven food groups divided by seven food groups in the previous 24-hour sample among the children aged 6–24 months.

MAD is composite indicator of MDD and MMF, where breastfed children meeting both criteria are Moaning to have met MAD.

The appropriate complementary feeding was assessed for a child currently breastfeeding, complementary food at 6 months age, MMF and MDD Appropriate complementary feeding was taken to be Appropriate, and inappropriate complementary feeding.

Data Collection

A pre-tested semi-structured interviewer-administered questionnaire was used to collect data on Sociodemographic characteristics, complementary feeding practices, 24-hour diet recall and food frequency. Three research assistants were trained on the instrument and conducted the interview along with the principle investigator.

Data analysis procedures

Data were used to enter Epi-Data version 3.1, and exported to SPSS, version 23.0 windows for further analysis. Reliability of the equipment was checking using Cornbrash’s Alpha. The data was presented in descriptive statistics using tables and figures by computing the frequencies and percentages of Appropriate complementary feeding practices, Bivariate logistic regression analyses was done to identify candidate variables for adjusted regression at p-values of <0.05 and multivariable logistic regression were presented as p-value <0.05 with Adjusted Odds ratios (AOR) with 95% confidence intervals. All tests were two sided to determine statistical significance

Data quality management

To ensure Reliability and validity were checked using pilot testing, Cronbach’s alpha. The contents of this study were based on objectives and data was double entry validated through Epi-data software and data collectors were trained and oriented how to avoid errors during data collection.

The analysis of Appropriate Complementary Feeding Practices (ACFP) reveals significant associations with various socio-demographic factors. Notably, the age of the mother/caregiver emerges as a critical determinant, with 12% of those under 20 years, 60% of those aged 21-29 years, and 28% of those aged 30 or older adhering to correct CF practices. This association is statistically significant with a p-value of 0.048.

Furthermore, educational attainment plays a pivotal role, with 47% of individuals who attended school practicing appropriate feeding, compared to 53% among those who did not. Family income also influences adherence, with 33% of families earning ≤ 150 USD, 28% earning 151-250 USD, and 39% earning ≥ 251 USD following appropriate practices.

Family size emerges as another crucial variable, with 49% of families with fewer than four members adhering better to appropriate feeding practices, compared to 51% in larger families (5 or more members). The gender of the child is also significant, as 43% of girls receive appropriate complementary feeding, compared to 57% of boys.

Age of the child is a key determinant, with 27% of children aged 6-8 months receiving appropriate feeds, contrasting sharply with 17% at 9-11 months and 56% at 12-24 months. Antenatal care visits also demonstrate significance, with 60% of attendees following appropriate feeding guidelines compared to 40% of non-attendees. Lastly, the number of antenatal care visits correlates with feeding practices, as 54% of women attending less than four times adhere to appropriate practices, compared to 46% of those attending four or more times.

Table 1: distribution of Complementary feeding practices by characteristics of nursing Mothers in Hargeisa, Republic of Somaliland 2024

Variable	Appropriate complementary feeding Practice (ACFP)
Variable	Appropriate N (%)	Inappropriate N (%)
Age of the mother/caregiver
<20 years	19 (12%)	15 (7%)
21-29 years	102 (60%)	183 (92%)
≥30 years	49 (28%)	2 (1%)
Ever attend school
Yes	81 (47%)	80 (40%)
No	89 (53%)	120 (60%)
Monthly income of the family
≤ 150 USD	56 (33%)	41 (21%)
151-250 USD	48 (28%)	155 (77%)
≥ 251 USD	66 (39%)	4 (2%)
Family Size
<4	83 (49%)	160 (80%)
≥5	87 (51%)	40 (20%)
Sex of the child
Girl	73 (43%)	106 (53%)
Boy	97 (57%)	94 (47%)
Age of the child in months
6-8 Months	46 (27%)	38 (19%)
9-11 Months	28 (17%)	80 (40%)
12-24 Months	96 (56)	82 (41%)
Ante Natal Care visit
Yes	103 (60%)	147 (74%)
No	67 (40%)	53 (26%)
Number of Antenatal Care Visit
< 4 visits	91 (54%)	41 (21%)
≥ 4 visits	79 (46%)	159 (79%)

The feeding practices among infants and young children across different age groups reveal notable trends. The vast majority of children meet the recommended minimum frequency of meals, with 95% at 6-8 months, 90% at 9-11 months, and 30% at 12-24 months. There is a significant disparity in meeting the minimum dietary diversity criteria, with only 46% at 6-8 months, 78% at 9-11 months, and 76% at 12-24 months.

Similarly, there is a notable difference in meeting the minimum acceptable diet criteria, with 30% at 6-8 months, 20% at 9-11 months, and 53% at 12-24 months. The timely introduction of complementary foods compared to the three months prior remains consistent across age groups, with 69% at 6-8 months, 66% at 9-11 months, and 52% at 12-24 months.

However, breastfeeding rates decline notably with age, showing 70% at 6-8 months, 68% at 9-11 months, and 54% at 12-24 months. Conversely, bottle feeding practices show a significant increase, with 70% at six to eight months, 68% at nine to eleven months, and 54% at twelve to twenty-four months.

Table 2: Complementary feeding practices among Infants aged from 6-24 months Using the WHO infant and yang child feeding Indicators by child Age in Months in Hargeisa, Republic of Somaliland 2024.

WHO IYCF Indicator	6-8 months	9-11 months	12-24 months	P-Value
WHO IYCF Indicator	N (%)	N (%)	N (%)	P-Value
Minimum meal frequency
Met	80 (95%)	96 (90%)	54 (30%)	<0.001
Not Met	4 (4%)	12 (11%)	124 (70%)	<0.001
Minimum Dietary Diversity (≥ 4 food groups)
Inadequate (≤ 4)	39 (46%)	85 (78%)	136 (76%)	<0.001
Adequate (≥ 5)	45 (54%)	23 (22%)	42 (24%)	<0.001
Minimum Acceptable Diet
Met	25 (30%)	21 (20%)	94 (53%)	<0.001
Not met	59 (70%)	87 (80%)	84 (47%)	<0.001
Timely Introduction of complementary foods at 6 months
Yes	58 (69%)	71 (66%)	91 (52%)	0.006
No	26 (31%)	37 (34%)	87 (48%)	0.006
Bottle feeding practice
Yes	59 (70%)	74 (68%)	97 (54%)	0.013
No	25 (30%)	34 (32%)	81 (46%)	0.013
Appropriate complementary feeding (ACF)
Inappropriate	38 (45%)	80 (74%)	82 (46%)	<0.001
Appropriate	46 (55%)	28 (26%)	96 (54%)	<0.001

The summary of the infant and child feeding habits for different age groups revealed a set of remarkable and indisputable observations. To begin with, infants’ breastfeeding rate drops sharply whereas at the age of 12-24 months only 20.1% infants breastfeed rather than 35.1% at 6-8 months. Then, there is the rise of the bottle feeding fashion from 28.2% to 36.9% at 6-8 months and 12-24 months respectively. It implies a change in the feeding techniques as the baby grows older, perhaps related with age-specific nutrients or evolution of the mother and society as new feeding patterns arise.

As an additional point, dietary diversity as well as food group frequency demonstrates a reduction in proportion to age increase. The share of infants with poor Dietary Diversity Scores skyrockets in line with the number of infants with the low Food Group Frequency Score increasing from 21.3% at 6-8 months to 69.1% at 12-24 months. The findings indicate the difficulties in achieving a diet with variety of foods and a balance for the infants and children as they get old, this requires interventions that would promote healthier feeding practices and dietary variety among the world population. Furthermore, the feeding frequency gets f faster with the growth of the infants which could indicate a shift towards more frequent feeding patterns involving higher energy needs and progressing developmental milestones. Generally, these trends underscores the need for focused interventions that will promote adequate feeding practices across infancy period and early childhood to bolster mothers to continue breastfeeding and eat variety.

Table 3: Complementary feeding practices among Infants aged from 6-24 months Using infant and child feeding Index components in Hargeisa, Republic of Somaliland 2024

ICFI Components	6-8 months	9-11 months	12-24 months	6-24 months	P-value
ICFI Components	N (%)	N (%)	N (%)	N (%)
Current breastfeeding status
Yes	84 (35.1%)	107 (44.8%)	48 (20.1%)	239 (64.6%)	<0.001
No	0	1 (1%)	130 (99%)	131 (35.4%)	<0.001
Bottle feeding practice
Yes	59 (70%)	74 (68%)	97 (56%)	230 (80.5%)	0.0013
No	25 (30%)	34 (32%)	81 (44%)	131 (19.5%)	0.0013
Dietary Diversity Score
Low (0)	23 (19.2%)	14 (11.7%)	83 (69.1%)	120 (32.4%)	<0.001
Medium (1)	30 (17.9%)	69 (41.1%)	69 (41.1%)	168 (45.4%)
High (2)	31 (37.8%)	25 (30.5%)	26 (31.7%)	82 (22.2%)
Food Group frequency Score
Low (0-2)	19 (21.3%)	14 (15.7%)	56 (62.9%)	89 (24.1%)	<0.001
Medium (3-4)	30 (16.5%)	69 (37.9%)	83 (45.6%)	182 (49.2%)
High (5-6)	35 (35.4%)	25 (25.3%)	39 (39.4%)	99 (26.8%)
Feeding frequency score
Low (0)	7 (6.3%)	3 (2.7%)	101 (91.0)	111 (30.0%)	<0.001
Medium (1)	52 (43.3%)	38 (31.7%)	30 (25.0%)	120 (32.4%)
High (2)	25(18.0%)	67 (48.2%)	47 (33.8%)	139 (37.6%)
ICFI categories
Low (0-4)	48 (31.6%)	51(33.6%)	53 (34.9%	152 (41.1%)	<0.001
Medium (5-8)	5 (7.0%)	12 (16.9%)	54 (76.1%)	71 (19.2%)
High (9-12)	31 (21.1%	45 (30.6%	71 (48.3%)	147 (39.7%)

The result of the Infant and Child Feeding Index (ICFI) Score analysis shows that it is correlated with a number of maternal and demographic variables. maternal age emerges as a key determinant, with a majority of caregivers under 20 years exhibiting low ICFI scores (73.5%), while those aged 21 to 29 are more likely to have high ICFI scores (46.7%). This association is statistically significant with a p-value less than 0.001.

Education, above all else, proves to be crucial, with a considerable proportion of caregivers who attended school showing a more balanced distribution across ICFI scores, particularly 29.2% in the high category, compared to only 11.8% among non-attendees.

Family income also correlates with ICFI scores, with a higher percentage of high ICFI scores evident for families earning ≥251 USD (24.3%), compared to families earning ≤150 USD (9.3%). Furthermore, larger families, i.e., those with 5 or more members, demonstrate a higher proportion of medium and high ICFI scores. Gender-related feeding practices show disparity, with a greater proportion of boys scoring highly on ICFI (42.9%) compared to girls (36.3%).

The age of the child is another crucial factor, with younger infants (6-8 months) more likely to exhibit low ICFI scores (57.1%) compared to older age groups, Antenatal care (ANC) attendance positively influences feeding practices, as mothers who attended ANC have a higher proportion of medium and high ICFI scores (82%) compared to non-attenders (18%).

Moreover, the number of ANC visits further impacts feeding practices, with a higher proportion of medium and high ICFI scores among mothers who had ≥4 visits (82%), compared to those with <4 visits (18%).

These findings underscore the intricate interplay of socio-demographic factors in shaping infant and child feeding practices, emphasizing the need for tailored interventions to address specific determinants and promote improved nutritional outcomes for infants and young children.

Table 4: Comparison between mothers who have high, medium and low infant and child feeding index among socio demographic variables in Hargeisa, Republic of Somaliland 2024

Variable	infant and child feeding index scores (ICFI)
Variable	Low ICFI *N (%)*	Medium ICFI *N (%)*	High ICFI *N (%)*	P-value
Age of the mother/caregiver
<20 years	25 (73.5%)	3 (8.8%)	6 (17.6%)	< 0.001
21-29 years	110 (38.6%)	42 (14.7%)	133 (46.7%)
≥30 years	17 (33.3%)	26 (51.0%)	8 (15.7%)
Ever attend school
Yes	95 (59.0%	19 (11.8%	47 (29.2%)	< 0.001
No	57 (27.3%)	52 (24.9%)	100 (47.8%)	< 0.001
Monthly income of the family
≤ 150 USD	56 (57.7%)	9 (9.3%)	32 (33.0%)	< 0.001
151-250 USD	78 (38.4%)	27 (13.3%)	98 (48.3%)
≥ 251 USD	18 (25.7%)	35 (50.0%)	17 (24.3%)
Family Size
<4	118 (48.6%)	25 (10.3%)	100 (41.2%	< 0.001
≥5	34 (26.8%)	46 (36.2%)	47 (37.0%)	< 0.001
Sex of the child
Girl	96 (53.6%)	18 (10.1%)	65 (36.3%)	< 0.001
Boy	56 (29.3%)	53 (27.7%)	82 (42.9%)	< 0.001
Age of the child in months
6-8 Months	48 (57.1%)	5 (6.0%)	31 (36.9%)	< 0.001
9-11 Months	51 (47.2%)	12 (11.1%)	45 (41.7%)
12-24 Months	53 (29.8%)	54 (30.3%)	71 (39.9%)
Ante Natal Care visit
Yes	106 (70%)	24 (34%)	120 (82%)	< 0.001
No	46 (30%)	47(66%)	27 (18%)	< 0.001
Number of Antenatal Care Visit
< 4 visits	74 (48%)	31 (44%)	27 (18%)	< 0.001
≥ 4 visits	78 (52%)	40 (46%)	120 (82%)	< 0.001

In a study analyzing factors associated with appropriate complementary feeding practices (ACFP) among mothers in Hargeisa, Somaliland, several key variables were examined for their impact on feeding practices. The analysis provided both Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) alongside 95% Confidence Intervals (CI) and p-values to ascertain the strength and significance of these associations. Notable findings include the positive impact of being unemployed on ACFP (AOR=3.5, 95% CI: 2.15-5.69, p<0.001), indicating that unemployed mothers are more likely to practice ACFP compared to their employed counterparts. Large family size (≥5 members) was another significant factor, with an AOR of 4.193 (95% CI: 2.650-6.634, p<0.001), suggesting families with more members are likelier to adopt ACFP. Avoiding bottle feeding (AOR=2.907, 95% CI: 1.88-4.49, p<0.001) and maintaining good WASH and hygiene status (AOR=4.488, 95% CI: 2.86-7.05, p<0.001) were also associated with higher ACFP adherence. Furthermore, dietary factors played a crucial role; adequate dietary diversity (AOR=0.032, 95% CI: 0.05-0.068, p<0.001) and meeting the minimum acceptable diet (AOR=0.012, 95% CI: 0.005-0.027, p<0.001) were highly indicative of appropriate feeding practices. Additionally, the timely introduction of complementary foods at 6 months significantly favored ACFP (AOR=2.504, 95% CI: 1.636-3.832, p<0.001).

Table 5: Factors Associated Appropriate Complementary feeding practices among Infants aged from 6-24 months Clinics in Hargeisa, Republic of Somaliland

Variables	Appropriate complementary feeding Practice (ACFP)		COR[95% CI]	AOR[95% CI]
Variables	Appropriate N (%)	Inappropriate N (%)	COR[95% CI]	AOR[95% CI]
Occupational Status
Unemployed	102 (60%)	168 (84%)	1 (Ref)	1 (Ref)
Employed	68 (40%)	32 (16%)	2.25 (1.32, 3.84)*	3.5 (2.15, 5.69)**
Family Size
≤4	83 (49%)	160 (80%)	1 (Ref)	1 (Ref)
≥5	87 (51%)	40 (20%)	2.7 (1.633, 4.45)**	4.193 (2.650, 6.634)**
Bottle feeding practice
Yes	83 (49%)	147 (73%)	1 (Ref)	1 (Ref)
No	87 (51%	53 (27%)	2.1 (1.27, 3.26) *	2.907 (1.88, 4.49)**
WASH and Hygiene status
Poor	130 (77%)	84 (42%)	1 (Ref)	1 (Ref)
Good	40 (23%)	116 (58%)	3.1 (1.12, 8.38) *	4.488 (2.86, 7.05)**
Dietary Diversity Score
Inadequate ( ≥ 5)	69 (41%	191 (95%)	1 (Ref)	1 (Ref)
adequate (≤ 4)	101 (59%)	9 (5%)	.017 (.005, .060)**	.032 (0.05, 0.068)**
Minimum Acceptable Diet
Met	132 (78%)	8 (6%)	1 (Ref)	1 (Ref)
Not met	38 (22%)	192 (94%)	.021 (.008, .053)**	.012 (.005, .027)**
Timely Introduction of complementary foods (at 6 months)
No	89 (52%	61 (31%)	1 (Ref)	1 (Ref)
Yes	81 (48%)	139 (69%)	6.5 (2.19, 18.73)*	2.504 (1.636, 3.832)**
COR : Crude Odds Ratio, AOR: Adjusted Odds Ratio * indicate p-value less than 0.05, ** p-value less than 0.001

The findings of the current study provide valuable insights into infant and child feeding practices (ACFP) and underscore the importance of socio-demographic factors in shaping these practices. Comparison with previous researches highlights both consistencies and disparities, shedding light on evolving trends and persistent challenges in infant and child nutrition.

The overall prevalence of appropriate complementary feeding practice among children aged from 6–24 months is 46% which is slightly low compared to other previous studies including several studies have investigated the prevalence of appropriate complementary feeding practices among children aged 6–24 months, consistently revealing suboptimal rates worldwide. For instance, a study conducted in Ethiopia found that only 25.2% of children received appropriate complementary feeding practices (Kassa, Meshesha et al. 2016) Similarly, research in Nepal reported a prevalence of 38.3%, indicating inadequate feeding practices among infants and young children (Kabir, Khanam et al. 2012). In contrast, a study in Nigeria demonstrated a slightly higher prevalence of 51.3%, yet still reflecting insufficient adherence to recommended feeding guidelines. These findings collectively underscore the global challenge of achieving adequate complementary feeding practices and highlight the urgent need for targeted interventions to improve child nutrition and health outcomes.

In our study, the proportion of mothers/caregivers below 20 years practicing Appropriate complementary feeding practice were 12%, contrasting with 60% among those aged 21–29 years and only 28% among those aged 30 years or older. These figures corroborate with previous studies by (Sharma, Gernand et al. 2008) which emphasized the vulnerability of younger mothers to suboptimal feeding practices, underlining the need for targeted interventions in this demographic group.

Similarly, our findings regarding the association between level of education and adherence to safe feeding practices align with the conclusions of studies conducted by, (White, Bégin et al. 2017, Appleton, Laws et al. 2018) which reported higher rates of appropriate feeding among educated mothers compared to those with lower levels of education. Our study reinforces the importance of educational initiatives in promoting optimal nutrition among caregivers.

Furthermore, the influence of family income on feeding practices echoes the findings of research by (Green, Anderson et al. 2011), which highlighted disparities in feeding practices based on socioeconomic status. The observed decline in breastfeeding rates and the rise in bottle feeding practices with increasing child age are consistent with the longitudinal trends reported by) (Jones, Steer et al. 2010), emphasizing the need for sustained efforts to support breastfeeding beyond infancy.

The Infant and Child Feeding Index (ICFI) analysis in our study revealed correlations with maternal and demographic variables, consistent with the findings of studies by (Davis, Clark et al. 2005) These findings underscore the intricate interplay of socio-demographic factors in shaping feeding practices, emphasizing the need for tailored interventions to address specific determinants and promote improved nutritional outcomes for infants and young children.

While our study contributes to the existing body of research on infant and child feeding practices, it also highlights areas for further exploration and intervention. Future studies could delve deeper into the cultural and environmental factors influencing feeding practices, as well as explore innovative approaches to address disparities and promote optimal nutrition among vulnerable populations.

The study has certain limitations that should be considered. The evaluation of children's feeding relied on maternal recollection of the foods consumed, introducing the possibility of recall bias as some mothers may have either exaggerated or underestimated their children's food intake, or not maintained the necessary level of attentiveness. Additionally, it is noteworthy that not all mothers seek services from primary health facilities, even though the participants were chosen to represent a diverse sample. Furthermore, the research was conducted in a cross-sectional manner, offering only a descriptive snapshot of maternal complementary feeding practices during the study period. Conducting longitudinal studies would enhance our understanding of the factors influencing these practices and their potential impact on the nutritional status of children.

The findings of our study underscore the intricate relationship between socio-demographic factors and infant and child feeding practices. Our research highlights disparities in feeding practices based on maternal age, education, family income, family size, and child age, emphasizing the need for tailored interventions to address these variations.

The observed decline in breastfeeding rates with increasing child age and the rise in bottle feeding practices signal evolving trends in infant nutrition, necessitating sustained efforts to promote breastfeeding beyond infancy. Moreover, the association between maternal age, education, and family income with adherence to safe feeding practices underscores the importance of educational initiatives and financial support for vulnerable populations.

The Infant and Child Feeding Index (ICFI) analysis reveals correlations with maternal and demographic variables, highlighting the complex interplay of socio-demographic factors in shaping feeding practices. These findings provide valuable insights for policymakers, healthcare providers, and community stakeholders to develop targeted interventions that address specific determinants and promote improved nutritional outcomes for infants and young children.

WHO: World Health Organization, IYCF: Infant and Young Child Feeding Practice FSNAU: Food Security and Nutrition Assessment Unit ICFI: Infant and Child Feeding Index, MDD: Minimum Dietary Diversity, MMF: Minimum Meal Frequency, MAD: Minimum Adequate Diet, LGA: Local Government Administration, PHCs: Primary Health Centers, SPSS: Statistical package for Social Sciences, OR: Odss Ratio, AOR: Adjusted Odss Ratio

The authors, Hamse Kh. Hassan., Abdeta M. Ahmed, and Mohamed A. Ahmed, declare no conflicts of interest regarding the publication of this research article. No financial or non-financial interests have influenced the study design, data collection, analysis, interpretation, or reporting of the findings presented in this manuscript.

Ethical Approval

Ethical approval was obtained from the Ethics Committee of the AAMUC Institutional Review Board Informed consent was obtained from the mothers with an assurance of confidentiality.

Funding sources

No external funding was received for the research, the statement "No external funding was received for this study"

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author, Hamse Khalif Hassan, upon reasonable request. Due to privacy and confidentiality concerns, the raw data cannot be publicly shared. However, summarized data and relevant statistical analyses will be provided to interested parties upon request and with appropriate permissions from the relevant institutional review boards.

Author Contributions:

Conceptualization: Hamse Kh. Hassan

Data curation: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

Formal analysis: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed..

Investigation: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

Methodology: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

Project administration: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

Resources: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

Software: Hamse Kh. Hassan

Supervision: Hamse Kh. Hassan

Validation: Hamse Kh. Hassan

Visualization: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

Writing – original draft: Hamse Kh. Hassan

Writing – review & editing: Hamse Kh. Hassan, Abdeta M. Ahmed, Mohamed A. Ahmed.

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No competing interests reported.

Assessment of Complementary Feeding Practices and Associated Factors among Infants Aged from 6-24 months in Hargeisa, Republic of Somaliland: A Cross-Sectional Study in 2024"

Status:

Version 1

Abstract

Background

Materials and Methods

Study design, area and setting

Data Collection

Data analysis procedures

Data quality management

Results and Discussion

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1