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Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.
The current study was conducted in Gale Mirga kebele (the lowest administrative unit in Ethiopia) of Kersa district of eastern Ethiopia from March to September 2016 (Figure 1). Kersa district has 35 kebeles; each comprises approximately 1000 households. The setting was selected as it was one of the food-insecure districts of the eastern Hareghe zone and the hotspots of El Niño. According to the 2014 nutrition causal analysis, the district’s general acute malnutrition and severe acute malnutrition rate was 7.5% and 0.8%, respectively. The availability of complementary foods was also suboptimal, with 73% of the main food prepared coming from sorghum and 19.9% from maize, reflecting food insecurity and the utilization of available resources at home [21]. According to Kersa Demographic and Surveillance data, the district crude birth and death rates are 37.2 and 7.8 per 1000 population, respectively. The district infant and under-five mortality rates were 46.9 and 77.4 per 1000 live births, respectively (Aseffa et al., 2015). The mortality figures are comparable to national-level infant mortality (48 per 1000 live births) but higher than national under-five mortality (67 per 1000 live births) rates [4]. The Sustainable Development Goal has set a target to reduce the under-5 mortality rate to less than 25 per 1000 live births [22]. The map of the study settings of Gale Mirga kebele, Kersa district, eastern Ethiopia. This study was an exploratory qualitative study with a basic interpretative qualitative approach [23] to uncover how the El Niño influenced complementary feeding practices. Participants were selected purposefully to represent diverse community roles and first-hand experiences of the effects of El Niño. To be included in the study, participants had to have one or more of the following roles: All HDA leaders, traditional birth attendants, and religious leaders in the district were invited to participate in the study. Mothers and fathers of children were invited based on their proximity to the meeting place. In recruiting participants, a letter of support was sent to the Kersa district health office that linked the research team to the health-extension workers of the Gale Mirga kebele. The health-extension workers provided the research team with information on the eligible study participants, which informed the sampling procedure and venue for focus group discussions (FGDs). Separate FGDs were conducted for each group. Data collection and analysis took place without deciding a priori the sample size, i.e., data collection went on until the ongoing inquiry revealed no new data. Focus group discussions were held at local primary school classrooms, which provided a quiet and private environment. Each FGD was facilitated by two researchers of Haramaya University who had Master’s Degree qualifications, previous experience of moderating FGD, and excellent native language (Afaan Oromo) proficiency. Focus groups were audio-recorded and observed, and a moderator took notes. The participants informed the plain language summary of the study objective and procedures, benefits, and risks of participation and their rights and obtained consent ahead of the data collection. At the start of a focus group, a moderator acknowledged the presence of the audio-recording equipment, assured participants of confidentiality, and allowed people to withdraw if they were uncomfortable with being audio-recorded. Concerning the researchers’ position in this study, Haramaya University has a Demographic and Health Survey setting in the district, but not in this specific kebele; hence, investigators had less knowledge about the study setting. Researchers were vigilant to a predisposition to their previous knowledge of the study settings on the study, if any. The sociodemographic data of participants were collected. Participants were asked about locally produced foods, those included in complementary foods and how complementary feeding practices are affected by household food insecurity related to El Niño. Although the communities were affected by chronic food insecurity from the failed rainy season, a distinction was made with El Niño using the information on severity and duration of most extreme events predicted by the Famine Early Warning System Network [24]. Moreover, strategies used to manage household food insecurity and its relation to complementary feeding practices were inquired, taking into account variations across the FGD participants. The FGD’s audio recordings were transcribed verbatim and translated into English by the research team, who were fluent in the native language and in English [25]. The authenticity of the transcripts was verified by two authors who moderated the discussion. The two authors read and discussed the transcripts and compared them against the original recording. The data collection and analysis were conducted simultaneously to identify areas for further exploration in subsequent focus groups. A general inductive approach was used for the analysis [23]. The final version of each transcript was imported into ATLAS. ti 7 Windows for coding by the lead author and another researcher [26]. The initial codes were reduced into sub-themes and themes by bringing together the experience of the FGD participants.
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