Predictors of complementary feeding practices among children aged 6–23 months in five countries in the Middle East and North Africa region

Abstract

Ensuring diets of children aged 6-23 months meet recommended guidance is crucial for growth and development and for the prevention of malnutrition including stunting, wasting and micronutrient deficiencies. Despite some improvement, indicators related to undernutrition and overnutrition fall short of global targets in the Middle East and North Africa (MENA) region that consist of low-and middle-income countries witnessing political and social changes and a nutrition transition. This research aims at reviewing the situation related to the diets of children aged 6-23 months in five selected countries in the MENA region, examining factors affecting complementary feeding and providing recommendations for guiding effective strategies to improve it. The study triangulated data on complementary feeding status and predictors from semistructured interviews with 30 key informants, and multivariable analysis of household surveys in Egypt, Jordan, Lebanon, State of Palestine and Sudan including data on refugees in Lebanon and Jordan. There remain considerable gaps in complementary feeding differing noticeably among geographic areas. Findings from qualitative and quantitative analyses showed that maternal factors, including maternal education and age, household level factors such as paternal education and wealth, community-level factors (culture and geographic location), and utilization of health services, were associated with minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) at varied levels in the five countries. Interventions to improve complementary feeding practices should include actions tailored to the needs of the population at multiple levels including at the caregiver's level, household, service use, community and policy level.

Review of the Nutrition Situation in Jordan: Trends and Way Forward

“…Another explanation is that breast milk offers infants early exposure to a variety of flavors, which has been shown to enhance their food acceptance and food choices [ 82 , 83 ]. Moreover, the education level and knowledge about feeding practices of mothers in Jordan were shown to be significant determining factors to the adequate diet of children aged 6–23 months [ 81 ], which was in line with other findings in the literature [ 84 , 85 , 86 , 87 ]. Other crucial elements affecting complementary feeding practices include low socio-economic status, food insecurity, as well as traditional cultural practices such as the provision of sugar-sweetened water for treating jaundice in children in certain rural areas [ 81 , 88 , 89 , 90 , 91 , 92 ].…”

“…In terms of complementary feeding, although most infants were introduced to solid, semi-solid, or soft foods as per the WHO recommendations [ 15 ], less than half of those aged 6–23 months received a minimum acceptable diet and minimum diet diversity. A decreasing trend, rather than improvement, was recorded in all the core complementary feeding indicators hence requiring interventions [ 15 , 81 ]. Studies have shown that breastfeeding may be associated with higher diet diversity and lower consumption of sugar, fat, and salt [ 81 , 82 ].…”

“…A decreasing trend, rather than improvement, was recorded in all the core complementary feeding indicators hence requiring interventions [ 15 , 81 ]. Studies have shown that breastfeeding may be associated with higher diet diversity and lower consumption of sugar, fat, and salt [ 81 , 82 ]. One hypothesis is that caregivers who follow recommendations pertinent to breastfeeding are more likely to adhere to other guidelines such as the provision of healthier foods and behaviors [ 82 ].…”

“…It is also important to incorporate community initiatives to address the challenges faced by breastfeeding mothers after their discharge from the hospital and throughout their second year postpartum [ 72 ]. As means of enhancing complementary feeding practices, it is crucial to design culture-specific nutrition awareness campaigns and education programs targeting all caregivers including fathers and grandparents, not just mothers, with emphasis on the less educated [ 81 , 84 , 133 ]. Moreover, the living conditions, food availability, and food security status among vulnerable populations and individuals residing in remote areas need to be improved to help enhance the diets of infants and young children [ 81 ].…”

“…As means of enhancing complementary feeding practices, it is crucial to design culture-specific nutrition awareness campaigns and education programs targeting all caregivers including fathers and grandparents, not just mothers, with emphasis on the less educated [ 81 , 84 , 133 ]. Moreover, the living conditions, food availability, and food security status among vulnerable populations and individuals residing in remote areas need to be improved to help enhance the diets of infants and young children [ 81 ]. The escalating prevalence of LBW highlights the need for governmental interventions and attention from national child health systems, in parallel to further investigating the underlying causes [ 3 , 38 ].…”