Complementary feeding and food‐group level inequality among Ethiopian children 6–23 months of age (2011–2019)

Abstract

Ensuring diet quality in the first 2 years of life is critical to preventing malnutrition and instilling healthy food preferences. Children's diet quality has changed little over time and inequalities by socioeconomic status, rural–urban residence, but also by food group may exist. Using data from the 2011, 2016 and 2019 demographic and health surveys (DHS), we estimated the prevalence and inequalities in the minimum diet diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). We further assessed food group‐level inequities. In 2019, only 13.5% of children 6–23 months of age met the MDD, 55% met the MMF and only 11% met the MAD indicator. Absolute and relative measures of inequality were calculated. Modest increases in MDD, MMF and MAD were observed over the past decade (2011–2019). These modest improvements were concentrated in limited geographical areas, among children in wealthier households, and urban residents. Unhealthy practices such as bottle‐feeding and zero fruit and vegetables have been increasing; whereas, inequities in the consumption of nutrient‐dense foods have widened. Nevertheless, children from the wealthiest quintile also failed to meet the MDD. Multisectoral efforts that span from diversifying the food supply, regulating the marketing of unhealthy foods, and promoting minimal processing of perishables (i.e., to extend shelf‐life) are needed. Context‐adapted behavioural change communication along with nutrition‐sensitive social protection schemes are also needed to equitably improve the diet quality of children in Ethiopia.

Time trends and social inequalities in infant and young child feeding practices: national estimates from Brazil’s Food and Nutrition Surveillance System, 2008–2019

“…This highlights the need for a broader understanding of complementary feeding practices in the context of food and nutrition insecurity ( 36 , 37 ) . Similar negative associations between MAD and low socio-economic status were also found in others studies, which used Demographic and Health Surveys data, conducted in low- and middle-income countries ( 19 , 34 , 38 ) .…”

“…This highlights the need for a broader understanding of complementary feeding practices in the context of food and nutrition insecurity (36,37) . Similar negative associations between MAD and low socio-economic status were also found in others studies, which used Demographic and Health Surveys data, conducted in low-and middleincome countries (19,34,38) . We observed a reduction in the percentage of children aged 6-24 months who consumed sweetened beverages and UPF, independently of the extreme poverty quintiles.…”

“…As an indicator which includes breast milk substitutes, MAD implies that children need to receive both diverse foods (MDD) in a recommended number of meals (minimum meal frequency) such as the consumption of six food groups a day. This condition may not be easy to achieve in poorer regions ( 34 ) . Certainly, many families still face the challenge of meeting minimum dietary standards for children ( 35 ) .…”

Feed handling practices, aflatoxin awareness and children's milk consumption in the Sidama region of southern Ethiopia

“…In line with earlier quantitative studies conducted in Ethiopia, our qualitative study indicated that milk consumption among children was relatively low or infrequent despite widespread cattle ownership [ 32 ]. However, this study revealed that the true nutrient intake from milk may be even lower than expected because, in this study setting at least, milk was given to children after extracting butter, and often are diluting the skim milk with water.…”

Addressing malnutrition in Ethiopia: A call for a systems approach to match the scope and complexity of the problem

“…Altogether, this suggests the need to ensure the safety of complementary foods through the implementation of baby WASH interventions (Waller et al, 2020). First, inequalities in diet, access to health care, and WASH need to be addressed (Girma et al, 2021;Tizazu et al, 2022). According to the studies by Girma et al (2021) and Tizazu et al (2022), rural households and those from lower socioeconomic status were those that could not afford to consume nutrient-dense food groups, access essential health-and WASH services; hence, were the most affected by various forms of malnutrition.…”