Ayu et al. BMC Pediatrics(2024) 24:573
https://doi.org/10.1186/s12887-024-05040-2

BMC Pediatrics

RESEARCH

Open Access

Inappropriate complementary feedingpractice and associated factors amongchildren aged 6–23 months in Shashemene,
Southern Ethiopia: a community-based crosssectional study
Ermias Girma Ayu1, Tsegaye Demissie Gemebo1, Debritu Nane1, Abel Daniel Kuche2 and Samson Kastro Dake1*
Abstract
Background Inappropriate complementary feeding is widely practiced in low and middle income countries. These
contribute to undernutrition, morbidity and mortality among young children. The incidence of malnutrition in thefirst two years of life has been directly linked with inappropriate complementary feeding practices along with highinfectious disease levels.
Objective To assess the level of inappropriate complementary feeding practice and associated factors amongchildren aged 6 to 23 months in Shashemene, Southern Ethiopia.
Method A community-based cross-sectional study was conducted from July to August 2021 among 609 children
aged 6 to 23 months paired with their caregivers. Systematic random sampling was used to identify study
participants. Data were analyzed by using SPSS version 25 software. Binary logistic regression analysis was used to
identify predictors of inappropriate complementary feeding practice. Statistical significance was determined using
Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI).
Results The prevalence of inappropriate complementary feeding practice among children aged 6–23 months
was 55.3%. Being a mother under the age of 25 years [AOR = 2.07, 95% CI: 1.30, 3.31], aged 25–34 years [AOR = 1.82,
95% CI: 1.14, 2.91], having an occupation [AOR = 2.73, 95% CI: 1.84, 4.05], and households where husbands’ arethe sole decision makers on their income [AOR = 2.41, 95% CI: 1.54, 3.77] increased the chance of inappropriate
complementary feeding practice. On the other hand, mother’s whose infants were aged 9–11 months [AOR = 0.30,
95% CI: 0.19–0.45] were less likely to practice inappropriate complementary feeding.
Conclusions The prevalence of inappropriate complementary feeding practice in the study area was high comparedto the WHO recommendation. Child’s age, maternal age, maternal occupation, and decision-making role on income
were found to be associated with inappropriate complementary feeding practice. Appropriate behavioral change*Correspondence:
Samson Kastro Daketasamsona@gmail.com
Full list of author information is available at the end of the article© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you
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Ayu et al. BMC Pediatrics(2024) 24:573

Page 2 of 7communication to family and community decision-makers, and involvement of husbands in infant and young childfeeding practice are recommendable.
Keywords Complementary feeding practice, Children, Undernutrition, Ethiopia

Background
The period from birth to two years of age is a “critical window” for the advancement of ideal development,
wellbeing and improvement, which are straightforwardly
subject to nourishment. The World Health Organization(WHO) recommends to exclusively breast-feed till six
months of age, and to start complementary feeding at six
months while continuing breast-feeding up to two years
or beyond [1].
Complementary feeding is the process of starting
other foods and liquids in addition to breast milk sincebreast milk alone is not sufficient to meet the nutritional
requirements of infants after six months of age [2]. Complementary feeding is considered as inappropriate when
it fails to fulfill either timely introduction of complementary feeding, minimum dietary diversity or minimum
meal frequency [2, 3].
Inappropriate complementary feeding is associatedwith a higher risk of undernutrition and mortality [4, 5].
Children who develop undernutrition early in their life
are in turn at increased risk of developing long lasting
effects on physical and cognitive growth during adulthood [6]. Children who take inappropriate complementary feeding will also develop diseases like diarrhea andtract infections, and end up in micronutrient deficiency
and growth failure [7].
Globally, 13% of deaths of children aged less than 5
years could be prevented with optimal breast-feeding andadditional 6% reduction could be achieved with appropriate complementary feeding practices [8]. Poor adherence
to the World Health Organization (WHO) and infant
and young child feeding (IYCF) guidelines may increase
the risk of respiratory and other infections [9]. Infants
develop more respiratory illness and eczema if complementary feeding is started before 6 months of age [10].
In addition, if complementary foods are not introduced
around the age of six months, or if they are given inappropriately, it leads to growth faltering in infants [11].
According to the Ethiopian Health and Demographic
Survey (EDHS) report, timely introduction of complementary feeding, dietary diversity and minimum meal
frequency were 69%, 14% and 55% respectively [12]. In
South Nations and Nationalities Peoples Region, only
2.5% of infants and young children meet minimum
dietary diversity and only 2.3% of them had the minimum acceptable diet [13]. Even though different efforts
were made by government to reduce inappropriate
complementary feeding practices through creating andimplementing IYCF practices and nutrition actions, theprevalence is still higher.
However, there is a scarcity of evidence on inappropriate complementary feeding practices and associatedfactors since most of the previous studies assessed thepredictors of appropriate complementary feeding rather
than inappropriate complementary feeding practice(ICFP). This study aimed to assess inappropriate complementary feeding practices and associated factors amongchildren aged 6–23 months in Shashemene, Southern
Ethiopia. The results of this study could help nutrition
programmers develop appropriate strategies to prevent
ICFP and enhance complementary feeding practices inthe study area. The findings of this study can be used as
an input by policymakers, program managers, health service providers, and other stakeholder that contribute toimproving IYCF in Ethiopia.

Methods
Study settingThis study was conducted in Shashemene town, Southern
Ethiopia. The town is located 255 km South from Addis
Ababa, the capital city of Ethiopia. There are eight kebeles(lowest administrative unit) in the town. The town has
286,477 residents; 144,484 men and 141,963 women. The
number of children aged 6 to 23 months in the town is12,260. In the town, there are two public and one private
hospitals, four public and one private health facilities, 61
clinics, and 59 pharmacies.
Study design and study period

A community-based cross-sectional study was conductedfrom July 1 to August 15 in 2021.
Population

All children aged 6 to 23 months paired with their mothers/primary care givers were the source population.
Selected children between 6 and 23 months of age pairedwith their mothers/primary care givers who lived in the
town for at least 6 months were studied. Infants andyoung children whose usual feeding pattern was changed
due to an illness that can affect their appetite during thestudy period were excluded from the study.
Sample size and sampling procedure

The sample size was determined by using assumptions of
single population proportion formula in Epi Info software
version 7.0 assuming 50.6% prevalence of ICFP [14], 95%
confidence level, 5% margin of error, 1.5 design effect,Ayu et al. BMC Pediatrics(2024) 24:573

and 10% non-response rate. The final sample size comprised 634 children aged 6 to 23 months paired with theirmothers or primary caregivers. Three kebeles (Burka
gudina kebele, Awasho kebele, and Arada kebele) wererandomly selected from eight kebeles of the town, andsystematic random sampling techniques was utilized to
select households with children aged 6–23 months. Proportional sample to population size allocation was madefor the three selected kebeles. House-to-house visits wereconducted to reach the target number of 609. When we
have more than one child in the same house between theages of 6 and 23 months, we selected the younger one forthe study. After selecting the eligible child, the mother ofthe child or the primary caregiver were interviewed.
Variables of the study

The outcome variable of this study was inappropriate
complementary feeding practice. The exposure variables
were mother or caregiver age, marital status, occupation, educational status, family size, monthly incomeof the family, exposure to media, decision making role
on household income, food restriction, age of the child,place of delivery assistance, birth order, and antenatal
visit.
Data collection procedures

Data were collected using a pre-tested structured interviewer-administered questionnaire. The questionnaire
was developed and adopted from the validated EDHS
and WHO questionnaire for IYCF [13, 15]. The questionnaire was initially prepared in English and translated
to Amharic and back translated to English by proficient
speakers of both languages. The questionnaire had different sections that address socio-demographic andeconomic, child feeding practice, and health services
characteristics. Mothers or primary caregivers withchildren aged 6 to 23 months were interviewed face-toface. Four BSc degree holder nurses were recruited andtrained for two days on data collection techniques andethics. The data collection was made using 24 h recall
dietary assessment method.
Operational definition

Timely introduction of complementary feeding Percentage of infants 6–8 months of age who consumed solid,
semi-solid or soft foods during the previous day [15].
Minimum dietary diversity Percentage of children 6–23
months of age who consumed foods and beverages fromat least five out of eight defined food groups during theprevious day. The eight food groups used to calculate
minimum dietary diversity were breast milk, grains, roots
and tubers, legumes, nuts and seeds, dairy products, flesh

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foods, eggs, vitamin A-rich fruits and vegetables, andother fruits and vegetables [15].
Minimum meal frequency Percentage of children 6–23
months of age who consumed solid, semi-solid or soft
foods (but also including milk feeds for non-breastfedchildren) the minimum number of times or more during
the previous day. Minimum is defined as two times forbreastfed infants 6–8 months; three times for breastfedchildren 9–23 months; and four times for non-breast children 6–23 months [15].
Inappropriate
complementary
feedingpractice Assessed by using the three key indicators recommended by WHO [15], which include timely introductionof complementary feeding, minimum dietary diversity,and minimum meal frequency. If the child did not fulfill
any of the three criteria, we classified the child as having
inappropriate complementary feeding practice.
Data processing and analysis

Data was checked, coded and entered to Epi data version
7.2 and exported to SPSS version 20 for analysis. Descriptive statistics like frequencies and proportions were used
to describe the data and presented using text and tables.
Binary logistic regression analysis was used to identify
the association between the outcome and exposure variables. The fitness of the model was checked using Hosmer-Lemeshow goodness-of-fit test and the p value was
0.279. Initially, bivariate analysis was carried out to identify candidate variables for multivariable analysis. Then,
those exposure variables with P < 0.25 were entered into
multivariable logistic regression to assess the degree ofassociation between outcome and exposure variables.
Adjusted Odds Ratio (AOR) with 95% confidence intervals (CI) was used to determine the level of association.

Results
Socio demographic and economic characteristics of study
subjects

The response rate of this study was 96.4%. More than halfof children (54.8%) were females and the median age ofthe children was 10.0 months. The majority (89.8%) ofcaregivers were married and 145 (23.8%) did not attend
formal education. One hundred fifty nine (26.1%) caregivers were housemakers. In terms of decision making
role on the expenditure of the household, 221(36.3%)
make decisions jointly (mothers and fathers of the children). More than half (61.4%) of caregivers listen to mass
media (Table 1).
Maternal obstetric and child feeding related characteristics

In this study, more than three fourth of the children(82.1%) were delivered at health facility. Two hundredAyu et al. BMC Pediatrics(2024) 24:573

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Table 1 Socio-demographic characteristics of the study
participants in Shashemene, Southern Ethiopia 2021
Variables (n = 609)
Sex of the childChild’s age in months

Caregivers age in years

Caregivers educational
statusCategory
Boy
Girl
6–8
9–11
12–23
< 25
25–34
>=35
No formal education

Primary (1st -8th )Secondary (9th -12th)
College and above
Marital status of caregiver Currently married
Currently notmarriedOccupation of theHomemaker
caregiver
Government
employee
NGO employee
Private business
Daily laborer
Household family size
<4
4–6
>6
Decision making on
Husbandhousehold expenditure
Wife
Jointly
Caregiver listen’s to mass Yes
media
No

Table 2 Maternal obstetric characteristics and feeding practiceof the study participants in Shashemene, Southern Ethiopia 2021

Frequency
275
334
228
164
217
235
235
139
145

Percent
45.2
54.8
37.4
26.9
35.6
38.6
38.6
22.8
23.8

140
157
167
547
62

23.0
25.8
27.4
89.8
10.2

159

26.1

162

26.6

84
172
32
125
272
212
191
197
221
374
235

13.8
28.2
5.3
20.5
44.7
34.8
31.4
32.3
36.3
61.4
38.6

ninety five (48.4%) of the children in the study were firstor second child in their family’s birth order. Nearly half
(48.9%) of the children had a birth interval of less than
24 months with their immediate elders. About half of the
caregivers (50.08%) had no ANC follow-up for the index
child. The majority (84.1%) of the caregivers did notreceive information about complementary feeding during their ANC visits to the health centers. The majority(95.4%) of the children have ever breastfed. More thanhalf (54.5%) of the children started breastfeeding immediately after birth and the majority (80.6%) of children are
currently breastfeeding (Table 2).
Prevalence of complementary feeding practice

The overall prevalence of ICFP of children’s aged 6–23
months in this study was 337(55.3%). The timely initiation of complementary feeding, minimum dietary diversity and minimum meal frequency were 46.3%, 74.5%,
and 73.6% respectively (Table 3).

Variables (n = 609)
Place of delivery
Birth order of the child in thefamilyInterval between the index
child & immediate elder
Attended ANC visits
Received information aboutcomplementary feeding in
ANC
Ever breast feed your childFirst put your child to breast

Child is currently
breastfeeding

Category
Home
Health facility
First or second
Third andabove
< 24 months
24 + months
Yes
No
Yes
No

Frequency
109
500
295
314

Percent
17.9
82.1
48.4
51.6

298
311
304
305
97
512

48.9
51.1
49.9
50.1
15.9
84.1

Yes
No
Within one
hour of birth
After one hour& before oneday
After one day
Yes
No

581
28
332

95.4
4.6
54.5

208

34.2

41
491
118

6.7
80.6
19.4

Table 3 Complementary feeding practice of the study
participants in Shashemene, Southern Ethiopia 2021
Variable
Timely introduction ofcomplementary feeding
Minimum dietary diversity
Minimum meal frequency
Currently breastfeeding
Inappropriate complementary feeding

Category
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Frequency
282
327
454
155
448
161
491
118
337
272

Percent
46.3
53.7
74.5
25.5
73.6
26.4
80.6
19.4
55.3
44.7

Factors associated with inappropriate complementary
feeding practices

Caregivers whose children were aged 9–11 months were
70% less likely to practice ICFP [AOR = 0.30, 95% CI: 0.19,
0.45]. On the other hand, caregivers under the age of 25
years and 25–34 years were about two times more likely
to practice ICFP compared to those mothers aged 35 orolder [AOR = 2.07, 95% CI: 1.30, 3.31] and [AOR = 1.82,
95% CI: 1.14, 2.91] respectively. Caregivers who have aregular job outside home were nearly three times more
likely to practice ICFP compared to their counterparts[AOR = 2.73, 95% CI: 1.84, 4.05]. Caregivers whose households expenditure was decided solely by husbands wereabout two times more likely to practice ICFP comparedto households whose expenditure was decided jointly[AOR = 2.41, 95% CI: 1.54–3.77] (Table 4).

Ayu et al. BMC Pediatrics(2024) 24:573

Page 5 of 7

Table 4 Factors associated with inappropriate complementary feeding practice of the study participants in Shashemene, Southern
Ethiopia 2021
Variable (n = 609)

ICFP
No (%)

Age of the children
6–8 months
136(59.6%)
9–11 months
59(36.0%)
12–23 months
142(65.4%)
Maternal age<= 24 years
142(60.4%)
25–34 years
128(54.5%)>= 35
67(48.2%)
Maternal occupation
Full time home
66(41.5%)
Have occupation
271(60.2%)
Maternal education
No formal education
72(49.7%)
Primary (1–8)
77(55.0%)
Secondary (9–12)
85(54.1%)
College & above
103(61.7%)
Attended ANC follow-up
Yes
161(53.0%)No
176(57.7%)
Decision making on household expenditure
Jointly118(53.4%)
Wife
94(47.7%)
Husband125(65.4%)
Listening to mass media
Yes
200(53.5%)
No
137(58.3%)

COR (95% CI)

AOR (95% CI)

92(40.4%)
105(64.0%)75(34.6%)

0.78[0.53–1.15]
0.30[0.19–0.45]
Ref

0.78[0.53–1.15]
0.30[0.19–0.45]*
Ref93(37.2%)
107(45.5%)72(51.8%)

1.64[1.08–2.50]
1.29[0.84–1.96]
Ref

2.07[1.30–3.31]*
1.82[1.14–2.91] *Ref

93(58.5%)
179(39.8%)

Ref
2.13[1.48–3.08]

Ref
2.73[1.84–4.05]*

73(50.3%)
63(45.0%)72(54.9%)64(38.3%)

0.61[0.39–0.96]
0.76[0.48–1.20]
0.73[0.47–1.14]
Ref

0.53[0.32–1.89]
0.74[0.44–1.24]
0.70[0.43–1.13]
Ref

143(47.0%)
129(42.3%)

Ref
1.21[0.88–1.67]

Ref
1.22[0.86–1.74]

103(46.6%)103(52.3%)
66(34.6%)

Ref
0.80[0.54–1.17]
1.65[1.11–2.46]

Ref
0.87[0.57–1.32]
2.41[1.54–3.77]*

174(46.5%)
98(41.7%)

Ref
1.22[0.88–1.69]

Ref
1.27[0.87–1.84]

Yes (%)*Statistical significance at p < 0.05

Discussion
This study has attempted to quantify inappropriate complementary feeding practices and identify the factors
associated with it among children aged 6–23 months.
The results of this study revealed that the prevalence of
ICFP was 55.3%. Age of the child, maternal age, maternal
occupation, and decision making on household income
were the variables identified to be significantly associatedwith inappropriate complementary feeding.
This study has reported 55.3% overall prevalence of
ICFP among children aged 6–23 months. The prevalenceof timely introduction of complementary feeding, minimum dietary diversity, and minimum meal frequency
were found to be 46.3%, 74.5%, and 73.6%, respectively.
This prevalence of ICFP is lower compared to a systematic review conducted in Ethiopia where the pooled prevalence of ICFP was 78.2% [16]. A study from Western
Ethiopia reported a prevalence level of 90.1% and anotherstudy from Southern Ethiopia reported 79% prevalenceof ICFP [17, 18]. A comparable prevalence level (46.5%)
was reported in Eastern Ethiopia [19]. When compared
to studies done in Nepal (70% and 82%) and Sri Lanka(84% and 88%), the finding of the current study shows

lower rates of timely introduction of complementary
foods and minimum meal frequency [8, 18]. A lower
prevalence of minimum diet diversity was reported in
Sudan (24%), Tanzania (38.2%) and Pakistan (22%) compared to the current study [20–22]. A higher minimum
meal frequency (63%) was reported in Pakistan [22].
These differences in the prevalence level could be attributed to the difference in the socio-demographic status of
the study areas. The current study was conducted in an
urban setting, whereas the previous studies conducted indifferent regions of Ethiopia included participants fromrural parts.
It was reported in the current study that mothers who
have children aged 9–11 months were 70% less likely topractice ICFP compared to their older counterparts. Thisfinding is consistent with other studies conducted in
Tanzania, West Africa, Bangladesh and Pakistan, where
mothers who have children 6–11 months were more
likely to practice ICFP [20, 23–26].
This research revealed that mothers under the age of
25 and those aged 25–34 years were about two times
more likely to practice ICFP compared to mothers aged
35 years and older. This finding is consistent with a studyAyu et al. BMC Pediatrics(2024) 24:573

done in the Middle East and North Africa region [21].
This might be because of the fact that exposure to childcare practices becomes better through experience asmaternal age increases [21].
According to the findings of the current study, maternal occupation was found to be an independent predictor of ICFP. Working mothers were about 2.7 times more
likely to practice ICFP than mothers who stayed at home[27]. This could be because employed women spend
most of their time outside of home and give less time andattention to their children. On the contrary, other studies conducted in Ethiopia and West Africa reported that
non-working mothers were more likely to practice ICFP
[26]. These studies have justified that women who does
not have their own income depend on their husband topurchase food for the children. However, in the current
study about 68.6% of the women involve in the decision
making of the household expenditure.
Mothers whose household expenses were decided byhusbands were 2.4 times more likely to practice ICFP
than households whose income expenses were decided
jointly. This finding is consistent with findings reported
in South Ethiopia [28]. This might be because husbands
are less likely to participate in complementary feedingpractice of their children in Ethiopian context [29]. The
responsibility of child feeding is on the shoulder of mothers and if they can access household resources, they cancontribute to child feeding [30].
Studies in different parts of the world have revealed
that maternal educational status, attending ANC and
Postnatal care follow-up, and exposed to mass media are
predictors of ICFP [23, 26, 27, 31]. However, these variables were found to have no association with ICFP in
the current study. In the current study, the proportionof women who gave birth at home, did not attend ANC
follow-up and did not receive information or counselling
about complementary feeding during ANC were significant. Studies have reported that women who gave birth
at home have a higher odds of practicing inappropriate
child feeding [32, 33]. Receiving information or counselling about complementary feeding was also a predictor inother studies [32, 34].
Limitations of the study

The study has interviewed the mothers about their pastexperience and may lead to possible recall bias. In addition, the study is a cross-sectional and thus it might not
be possible to determine cause-effect relationship.

Conclusions
Appropriate behavioral change communication to family and community decision-makers are essential for
improving complementary feeding practices with special
emphasis given to food demonstration activities, timely

Page 6 of 7

introduction of complementary feedings, and food frequency to boost the IYCF program. Specifically, mothers
should be made aware of their childrens’ (6–23 monthsold) food consumption and engaging husbands in IYCF is
essential. All mothers who attend a health facility should
get nutritional counseling on child feeding practice.
Abbreviations
ANC	Ante-Natal Care
AOR	Adjusted Odds Ratio
CI	Confidence Interval
COR	Crude Odds Ratio
EDHS	Ethiopian Demographic and Health Survey
ICFP	Inappropriate Complementary Feeding practice
IYCF	Infant and Young Child FeedingNGO	Non-Governmental Organization
SPSS	Statistical Software for Social ScienceWHO	World Health Organization
Acknowledgements
We would like to thank the School of Public Health, WSU institution review
board for providing ethical approval letter for this research process. We would
also like to acknowledge Shashemene Town Health office and local authorities
for giving permission and for their cooperation to conduct this study. We arealso grateful to the study participants for their voluntarily participation in the
study, and the data collectors and supervisors for their effort.
Author contributions
EGA conceived the study and involved in designing the protocol, coordinating
data collection, analyzing the data, and interpreting the findings. TD, DN,
ADK and SKD contributed to the design, analysis, and interpretation of thefindings, and reviewed progressive drafts of the manuscript and proofread themanuscript. All authors read and approved the final version of the manuscript.
Funding
No funding has been received to conduct this study.
Data availability
The datasets analyzed for this study are available with the corresponding
author which can be accessed on reasonable request.

Declarations
Ethics approval and consent to participate
Ethical clearance was obtained from the institutional review board at theCollege of Health Science and Medicine, Wolaita Sodo University in Ethiopia
with an ethical approval reference number CRCSO77/0113. Permission letter
together with the ethical clearance letter was presented to Shashemene town
health office and permission was obtained sequentially from this office andits lower administrative structures. Informed written consent was obtained
from each participants. Caregivers with a high perceived risk of poor feedingpractices were counseled about appropriate feeding practices after thecompletion of the interview.
Consent to publish
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1
College of Health Sciences and Medicine, School of Public Health,
Department of Reproductive Health and Human Nutrition, Wolaita Sodo
University, Wolaita Sodo, Ethiopia
2
College of Health Science and Medicine, School of Medicine,
Department of Pediatrics and Critical Care, Wolaita Sodo University,
Wolaita Sodo, Ethiopia
Received: 16 October 2023 / Accepted: 28 August 2024

Ayu et al. BMC Pediatrics(2024) 24:573

References
1. Mihretie Y. Assessment of complementary feeding practice of infants andyoung children aged 6–23 months in Gode Town. Somali Regional State of
Ethiopia; 2017.
2. WHO, UNICEF. Global strategy for infant and young child feeding. Geneve:
WHO; 2003.
3. Kassa T, Meshesha B, Haji Y, Ebrahim J. Appropriate complementary feedingpractices and associated factors among mothers of children age 6–23
months in Southern Ethiopia, 2015. BMC Pediatr. 2016;16(1):1–10.
4. Darnton-Hill I. Interventions for improving complementary feeding practices.
WHO; 2017.
5. Masuke R, Msuya SE, Mahande JM, Diarz EJ, Stray-Pedersen B, Jahanpour
O, et al. Effect of inappropriate complementary feeding practices on the
nutritional status of children aged 6–24 months in urban Moshi, Northern
Tanzania: Cohort study. PLoS ONE. 2021;16(5):e0250562.
6. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middleincome countries. Lancet. 2013;382(9890):427–51.
7. UNICEF, Bank WHO. W. Levels and trends in child malnutrition: key findingsof the 2020 Edition of the Joint child Malnutrition estimates. Geneva: WHO;2020.
8. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths
can we prevent this year? Lancet. 2003;362(9377):65–71.
9. Wormer JR, Shankar A, Van Hensbroek MB, Hindori-Mohangoo AD. Poor
adherence to the WHO guidelines on feeding practices increases the risk forrespiratory infections in Surinamese Preschool Children. 2021;18(20).
10. Ahmed KY, Page A, Arora A, Ogbo FA. Associations between infant and young
child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: a propensity score matching approach. PLoS ONE. 2020;15(4):e0230978.
11. WHO, Comlementary feeding Geneve WHO. 2023 [10/13/2023]. https://www.
who.int/health-topics/complementary-feeding#tab=tab_1
12. Institute EPH. ICF. Ethiopia Mini Demographic and Health Survey 2019: key
indicators. Maryland, USA: EPHI ICF;: Rockville; 2019.
13. Ethiopia. C, ICF. Ethiopia Demographic and Health Survey 2016 Key indicators
Report. Maryland, USA: CSA ICF;: Addis Ababa, Ethiopia Rockville; 2016.
14. Beyene M, Worku AG, Wassie MM. Dietary diversity, meal frequency andassociated factors among infant and young children in Northwest Ethiopia: across- sectional study. BMC Public Health. 2015;15:1007.
15. WHO, UNICEF. Indicators for assessing infant and young child feeding practices: definitions and measurement methods. Geneve: WHO; 2021.
16. Dagne AH, Zewude SB, Semahegn AM. Appropriate complementary feedingpractice and its Associated factors among mothers who have children aged
between 6 and 24 months in Ethiopia: systematic review and Meta-analysis. J
Nutr Metab. 2022;2022:1548390.
17. Fanta M, Cherie HA. Magnitude and determinants of appropriate complementary feeding practice among mothers of children age 6–23 months inWestern Ethiopia. 2020;15(12):e0244277.
18. Himbego DG, Hanfore LK, Dake SK. Appropriate complementary feedingpractice among mothers of 6–23 months old children in Kedida Gamela
district, south Ethiopia: a community based cross-sectional study. Int J Nutr
Metabolism. 2019;11(3):19–26.
19. Ebroshe M, Oljira L, Mengiste B, Adem HA, Alemu A, Fekadu G. Complementary feeding practices and associated factors among children aged 6–23
months in rural Haramaya district, Eastern Ethiopia: a community-based
cross-sectional study. Nutr Health. 2023;29(3):523–30.

Page 7 of 7

20. Victor R, Baines SK, Agho KE, Dibley MJ. Factors associated with inappropriate complementary feeding practices among children aged 6–23 months in
Tanzania. Matern Child Nutr. 2014;10(4):545–61.
21. Shaker-Berbari L, Qahoush Tyler V, Akik C. Predictors of complementary
feeding practices among children aged 6–23 months in five countries in the
Middle East and North Africa region. 2021;17(4):e13223.
22. Na M, Aguayo VM, Arimond M, Stewart CP. Risk factors of poor complementary feeding practices in Pakistani children aged 6–23 months: a multilevel
analysis of the demographic and Health Survey 2012–2013. 2017;13 Suppl
2(Suppl 2).
23. Na M, Aguayo VM, Arimond M, Stewart CP. Risk factors of poor complementary feeding practices in Pakistani children aged 6–23 months: a multilevel
analysis of the demographic and Health Survey 2012–2013. Matern Child
Nutr. 2017;13 Suppl 2(Suppl 2).
24. Chowdhury MR, Rahman MS, Khan MM. Levels and determinants ofcomplementary feeding based on meal frequency among children of 6 to 23
months in Bangladesh. BMC Public Health. 2016;16(1):944.
25. Issaka AI, Agho KE, Page AN, Burns PL, Stevens GJ, Dibley MJ. Determinantsof suboptimal complementary feeding practices among children aged
6–23 months in four anglophone west African countries. Matern Child Nutr.
2015;11(1Suppl 1):14–30.
26. Issaka AI, Agho KE, Page AN, Burns PL, Stevens GJ, Dibley MJ. Determinantsof suboptimal complementary feeding practices among children aged 6–23
months in seven francophone west African countries. Matern Child Nutr.
2015;11(1Suppl 1):31–52.
27. Joshi N, Agho KE, Dibley MJ, Senarath U, Tiwari K. Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary
data analysis of demographic and Health Survey 2006. Matern Child Nutr.
2012;8(Suppl 1):45–59.
28. Berhanu Z, Alemu T, Argaw D. Predictors of inappropriate complementary
feeding practice among children aged 6 to 23 months in Wonago District,
South Ethiopia, 2017; case control study. BMC Pediatr. 2019;19(1):146.
29. Wolkanto AA, Gemebo TD, Dake SK, Hailemariam TG. Fathers’ involvement incomplementary feeding of children in Damot Woyde District, South Ethiopia:
a community-based cross-sectional study. BMC Nutr. 2023;9(1):8.
30. Development AE, Office ATEC. Initial Insight Mining and Pretest Research for
Alive & Thrive Ethiopia. 2011.
31. Epheson B, Birhanu Z, Tamiru D, Feyissa GT. Complementary feeding practices
and associated factors in Damot Weydie District, Welayta Zone, South Ethiopia. BMC Public Health. 2018;18(1):419.
32. Tadesse M, Ali Dawed Y, Fentaw Z, Endawike A, Adamu K. Determinantsof inappropriate complementary feeding among children 6–23 monthsof age in Dessie City Northeast Ethiopia: a case-control study. BMC Nutr.
2023;9(1):124.
33. Sisay W, Edris M, Tariku A. Determinants of timely initiation of complementary
feeding among mothers with children aged 6–23 months in Lalibela District,
Northeast Ethiopia, 2015. BMC Public Health. 2016;16(1):884.
34. Biks GA, Tariku A, Wassie MM, Derso T. Mother’s infant and young child feeding (IYCF) knowledge improved timely initiation of complementary feedingof children aged 6–24 months in the rural population of northwest Ethiopia.
BMC Res Notes. 2018;11(1):593.

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