Background Inadequate complementary feeding is a major cause of childhood malnutrition. Malnutrition caused by insufficient complementary feeding accounts for more than one-third of all under-five mortality whereas appropriate feeding practices are critical for improving nutritional status and ensuring child survival. Thus, the objective of this study was to assess the prevalence of appropriate complementary feeding practices among mothers having 6–23 months children, from Feb.-march 2020 and associated factors in Shashemene Town, Oromia, Ethiopia. Methods From February to March of 2020, a community-based cross-sectional survey was conducted. 536 mothers with children aged 6 to 23 months were chosen for the study using a two-stage sampling procedure. Data was collected by Face-to-face interviews during home-to-home visits with mothers who had children aged 6–23 months, using a structured questionnaire on the main complementary feeding indicators. The Statistical Package for the Social Sciences (SPSS) software was used to analyze the data. Logistic regression was used to identify factors associated with appropriate complementary feeding practice, with statistical significance set at probability value < 0.05. Results The proportion of children aged 6–23 months who met the criteria for complementary food introduction, minimum meal frequency, minimum dietary diversity, minimum acceptable diet, and appropriate complementary feeding practices was 67.9 percent, 61.7 percent, 42.5 percent, 41.7 percent, and 30 percent, respectively. Child age 12–17 and 18–23 months were the independent factors associated with appropriate complementary feed practice [adjusted odd ratio (AOR): 2.32, 95 percent confidence interval (CI): (1.40–3.82)]. ** 1.91 (1.10–3.32) **. Socioeconomic status: mothers in the wealth index of the household, second, third, and fourth, [AOR: 4.27,95 percent, CI (1.8–10.22) ** 4.02(2.23–9.94) ** 7.02 (3.27–15.1) **], number of antenatal care visits greater than or equal to four [AOR: 2.57,95 percent, CI: (1.3–5.05)] **, information sources [AOR: 3.5,95 percent, CI: (1.45–8.26) **]. Conclusion This study found that children aged 6–23 months had a low level of appropriate complementary feeding practice. Mothers with children aged 6–11 months, the number of antenatal care (ANC) visits, socioeconomic status, sources of information, mothers’ knowledge, and positive attitude were all associated with appropriate feeding practices. As a result, nutritional education/counseling intervention on child feeding practices was suggested.
Shashemene is the most densely populated town in the Oromia region of Ethiopia, with a diverse ethnic population. It is located 250 kilometers from Addis Ababa, Ethiopia’s capital city. Shashemene town is located in the subtropical climatic zone: In 2019, the population of Shashemene town is estimated to be 272193, with 50.4 percent males and 49.6 percent females. According to the 2020 Shashemene Town report [18], children aged 6–23 months made up 4.8 percent of the population, or 13065 people. The research was carried out in Shashemene Town from February to March 2020. From February to March 2020, a community-based cross-sectional study was conducted in Shashemene, Oromia, Ethiopia. All mothers with children aged 6–23 months who lived in Shashemene town by 2020 were considered the source population, whereas mothers with children aged 6–23 months who lived in selected households during the study period and lived in the study area for more than 6 months were considered the study population. Mothers who resided in the study area for <6 months were excluded from the study subjects. The source population was all mothers-child pairs aged 6–23 months living in Shashamene town. Mother-child pairs aged 6–23 months living in selected households during the study period as well as those residing in the study area for 6 months presented during the study period were included as study subjects. Dependent variable was expressed as: Mothers’ complementary feeding practices which the response can be dichotomized and coded as [1 = Appropriate complementary feeding practice, 0 = inappropriate complementary feeding practice]. Appropriate complementary feeding practice: defined appropriate when they meet all the four Complementary feeding indicators timely introduction, minimum meal frequency and minimum dietary diversity and minimum acceptable diet and coded as 1 while it is considered inappropriate complementary feeding practice when it fails to fulfill even a single indicator [5, 6]. Timely introduction of complementary feeding: The proportion of children 6–23 months that were introduced to solid and semisolid foods at 6 months of age [5, 6]. Minimum dietary diversity: is the proportion of children 6–23 months of age who receive foods from 4 or more food groups with the food groups consisting; (I) grains, roots and tubers; (II) legumes and nuts; (III) dairy products; (IV) flesh foods; (V) eggs; (VI) vitamin A rich fruits and vegetables; and (vii) other fruits and vegetables during the previous day of study [5, 6]. Minimum meal frequency: is the proportion of breastfed and non-breastfed children 6–23 months of age, who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children) the minimum number of times or more during the previous day. Minimum is defined as 2 times for breastfed infants 6–8 months, 3 times for breastfed children 9–23 months, 4 times for non-breastfed children 6–23 months [5, 6]. Minimum acceptable diet: is the proportion of children 6–23 months of age who receive both minimum meal frequency and minimum dietary diversity during the previous day of study [5, 6]. Knowledge and attitude on appropriate complementary feeding practice (ACFP) was measured among respondents using CFP: Complementary feeding practices, #: number, ANC: Antenatal care, PNC: Postnatal care. Household food security was measured with the Household Hunger Scale (HHS) which has 9 items along with 9 frequencies (9I 9F) Household Food Insecurity Access Scale (HFIAS) [18]. The household food insecurity status was measured by direct survey of household consumption 4weeks preceding the survey. In this study, household food insecurity is dichotomous variable taking value 1 if the household is food insecure and 0 otherwise. The response categories are never (0 times), rarely (1–2 times), or sometimes (3–10 times), and often (more than 10 times). Therefore, the HHS was used in this study to define two groups; households reporting (a) little to no hunger in the past month because of insufficient food or because of lack of resources to get food and thereby classified as food secure households, and (b) moderate to severe hunger in the past month because of insufficient food or because of lack of resources to get food, and thereby classified as food insecure households. The sample size was calculated using a single population proportion formula considering the proportion of appropriate complementary feeding practice (11.4%) from a previous study [14]. The following assumptions were used: 243 samples were obtained with consideration of 10% contingency to non-responders a total of 536 mothers were sampled A two stage sampling technique was used to select the study subjects. Four (4) sub cities was randomly selected using simple random sampling method from 8 sub cities. The total population in the four (4) selected sub cities: Bulchana, Arada, Alelu and Awasho was 139510 (respectively 36877, 34529, 31734 and 36370 of which 6696 was children of 6–23 months of age. The calculated sample (536) was allocated equally among the selected 4 sub cities i.e. 134 mothers having children 6–23 months in each sub city. To select the individual sample units or subjects at household level, all target groups at each sub city was obtained from the health post then Kth was calculated. The random start was determined by lottery, and every Kth mother with eligible children was chosen from four sub-cities using systematic random sampling, so a child was chosen in each sub-city and his or her mother was interviewed accordingly. From each household, one eligible child with a mother at the time of the survey was chosen; if more than two eligible children were found, the younger was chosen, and the process was repeated until the next Kth in the same direction. If the mother was not present on the date of data collection, she was replaced by the next mother from the same sub city after one revisit [Fig 2]. Diagrammatic presentation of sampling scheme of the sampled mothers-child pairs of 623months age Shashamene, Ethiopia, 2020. D/Boke: Didaboke, pop(n): Population, B/gudina: Burka Gudina, m:month. The questionnaire was created by reviewing various literatures and then adapting it to the local context [5, 6, 13, 14]. Face-to-face interviews were conducted during home-to-home visits with mothers who had children aged 6–23 months, and data were collected using a structured questionnaire. The questionnaire included questions about the mothers and children’s backgrounds, maternal health practices, and child feeding practices. Face-to-face interviews were conducted during home-to-home visits with mothers who had children aged 6–23 months, and structured questionnaires were used to collect data. The questionnaire included questions about the mothers and children’s backgrounds, maternal health practices, and child feeding practices. Six diploma holders nurses were hired as data collectors, and two BSc holders were hired as supervisors. For data quality control, the questionnaire was first written in English, then translated into the local language, Afaan Oromo, and then back translated into English by two people who are fluent in both languages. Data collectors and supervisors were trained for two days, and the questionnaire was pre-tested 26 mothers in the study area who were not included in the actual study to assess the content and approach of the questionnaire, and necessary corrections were made. All questionnaires were checked for completeness on a daily basis, and data was thoroughly checked and cleaned before analysis. The questionnaires were created by reviewing various literatures and validating them in the context of our country. The statistical package for social science (SPSS) version 25 was used to code, enter, and analyze data. Data was described using descriptive statistics such as frequencies, proportions, means, and standard deviation. Bivariate analysis was performed to appreciate the relationship between each independent variable and the dependent variable. Finally, independent variables associated with P-value 0.25 during bivariate analysis were entered into multivariable logistic regression analysis, which was used to determine the strength of association between independent and dependent variables. Odds ratios with 95 percent confidence intervals were reported, and statistical significance was declared at a p-value of 0.05. To control for confounders, a multivariate logistic regression model was used. To handle the effect of residual confounding effect we took representative sample size. Beside this we used standardized questionnaire to include all variable that are important to measure ACFP as well we tried to control confounding with multivariate analysis. Using principal component analysis, the wealth index was calculated as a measure of household wealth (PCA). Fifteen variables were considered, including ownership of selected household assets, the size of the quantity of durable equipment, materials used in housing construction, and ownership of improved water and sanitation facilities. Finally, the resulting principal component was divided into five equal quintiles (lowest, second, middle, fourth, and highest). The Madda Walabu University (MWU) research and ethics committee reviewed and approved the research proposal. Permission was obtained from the appropriate authorities. The consent was in accordance with the ethical principle of "autonomy" statements, which give participants the right to stop/ withdraw from the study at any time. ‘before we collected data from each individual, information about informed verbal consent was provided then as the study was not invasive in nature the informed consent was obtained from each study participants or the parent or guardian. In short, the information sheets were available on each questionnaire then, we provided information about the purpose, procedures, benefits and disadvantage of the study for the participants or guardians. Informed due to the nature of the study was not invasive. Lastly, only participants who were willing to participate in the study were included. Moreover, those who wish to stop their participation at any stage were also permissible to do so without any restriction’. Finally, interviewers will inform respondents about the importance of appropriate CF practice and nutritional advice. In addition, intervention strategies will be developed in order to take appropriate action.
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