EC Nutrition

Background: The increasing practice of non-breastfeeding is a major concern, particularly in urban areas. Meal frequency measurement has different standards among non-breastfed children. However, the primary focus of nutrition studies has been on breastfeeding, leading to a lack of comprehensive data on meal frequency and its association with underweight status among non-breastfed infants.

Objective: This study was aimed at assessing the minimum meal frequency and its association with underweight among non-breastfed infants and young children aged 6 to 23 months in Hawassa city, Ethiopia, from May 12, 2024, to July 08, 2024.

Methods: A community-based cross-sectional study was conducted among 423 non-breastfed children aged 6 to 23 months in Hawassa City. First, the estimation was made to know whether there is an adequate sample of non-breastfed or not in the community. Then, the sample was allocated proportionally to all sub-cities based on population size. After that, one of the sub-cities was chosen at random, and the first non-breastfed child from that sub-city was identified. Finally, the collection process began with the identified child and proceeded using consecutive sampling. Data was collected using Kobo Collect­-enabled mobile phones, an interviewer-administered questionnaire, and a weight scale. The association between underweight and explanatory variables was assessed using binary logistic regression.

Result: A total of 420 respondents participated in the study. The percentage of non-breastfed children who fulfilled minimum meal frequency (MMF) was 62.9%, and the prevalence of underweight was 10%. Non-breastfed children who did not fulfill the MMF were 5.2 times more likely to be underweight compared to those who met the requirement per day (p = <.001, AOR; 5.2, 95% CI: 2.5, 11.0). Compared to the children whose mothers’ age was above 35, those children whose mothers’ age was between 15 and 24 and between 25 and 34 had a lower risk of being underweight (p = 0.04, AOR; 0.15, 95% CI: 0.02, 0.93) and (p = 0.03, AOR; 0.15, 95% CI: 0.03, 0.8), respectively.

Conclusion: The findings of our study indicated that about three out of five children were fed with meal frequency according to World Health Organization recommendations. Adherence to the recommendation of meal frequency might reduce the risk of being underweight. Studies incorporating qualitative approaches might be helpful in generating in-depth information to address the issue related to the causes of having lower meal frequency among non-breastfed IYC.

 Keywords: Non-Breastfed; Underweight; Minimum Meal Frequency; Non-Breastfed, Hawassa

1. USAID FANTA and FHI 360. “Developing tools to measure progress on infant and young child feeding” (2014).
2. World Health Organization and the United Nations Children’s Fund (UNICEF). “Indicators for assessing infant and young child feeding practices” (2021).
3. Ministry of Health Ethiopia. “Guideline for Infant and Young Child Feeding in Emergencies for Ethiopia” (2021).
4. World Health Organization and United Nations Children’s Fund. “Global Strategy for Infant and Young Child Feeding” (2002).
5. World Health Organization. “Malnutrition” (2024).
6. UNICEF WHO and The World Bank. “Levels and trends in child malnutrition” (2014).
7. Tekile KA., et al. “Prevalence of malnutrition and associated factors among under-five children in Ethiopia: evidence from the 2016 Ethiopia Demographic and Health Survey”. BMC Research Notes1 (2019): 391.
8. Ethiopian Public Health Institute (EPHI) Central Statistical Agency (CSA) WB USAID and UNICEF. “Mini Demographic and Health Survey 2019” (2021).
9. Tamir TT., et al. “Underweight and associated factors among children under age of five in low and lower-middle income African countries: hierarchical analysis of demographic and health survey data”. Frontiers in Public Health 12 (2024): 1423603.
10. Moshi CC., et al. “Determinants of underweight among children aged 0-23 months in Tanzania”. Food Science and Nutrition 4 (2022): 1167-1174.
11. Birhan YT and Angaw AD. “Trends and determinants of underweight among children under five years in Ethiopia: Further analysis with Ethiopian demographic and health survey 2005-2016-multivariate decomposition analysis”. Journal of Nutrition and Metabolism (2022): 6663756.
12. Fenta MH., et al. “Trends and determinants of underweight among under-five children in Ethiopia: Data from EDHS”. International Journal of Pediatrics (2020): 3291654.
13. Government of Ethiopia. “Seqota Declaration” (2015).
14. Federal Democratic Republic of Ethiopia. “National Nutrition Program 2016-2020” (2016).
15. Federal Democratic Republic of Ethiopia. “Food and Nutrition Policy” (2018).
16. “Annual report UNICEF Nutrition Ethiopia” (2022).
17. World Health Organization. “Indicators for assessing infant and young child feeding practices” (2008).
18. World Health Organization and the United Nations Children’s Fund. “Indicators for assessing infant and young child feeding practices” (2021).
19. Pan American Health Organization and World Health Organization. “Guiding principles for complementary feeding of the breastfed child” (2001).
20. World Health Organization. “Infant and young child feeding” (2009).
21. Akanji OO. “UNICEF the state of the world's children”. Economic and Financial Review 1 (1998).
22. Rai S and Unisa S. “Complementary feeding practices and underweight status among children age 6-23 months in India”. The Journal of Family Welfare 64 (2019).
23. Twabi HS., et al. “Evaluating the effect of appropriate complementary feeding practices on child growth in Malawi using cross-sectional data”. Frontiers in Nutrition 8 (2021): 714232.
24. Masuke R., et al. “Effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Northern Tanzania”. PLOS ONE 5 (2021): e0250562.
25. UNICEF (United Nations Children’s Fund). “Feed to fail” (2021).
26. Aboagyea RG., et al. “Prevalence and predictors of infant and young child feeding practices in sub-Saharan Africa”. International Health1 (2023): 68-82.
27. Wake DA. “Prevalence of minimum meal frequency practice and its associated factors among children aged 6 to 23 months in Ethiopia: A systematic review and meta-analysis”. Global Pediatric Health 8 (2021): 2333794X211026184.
28. World Health Organization. “Child mortality (under 5 years)” (2022).
29. Ethiopian Public Health Institute. “The cost of hunger in Ethiopia: Implications for Africa's social and economic transformation implications for the growth and transformation of Ethiopia” (2013).
30. Hossain M MM., et al. “Prevalence and risk factors of underweight among under-5 children in Bangladesh: Evidence from a countrywide cross-sectional study”. PLOS ONE 4 (2023): e0284797.
31. FAO IFAD UNICEF WFP and WHO. “The state of food security and nutrition in the world - Financing to end hunger, food insecurity and malnutrition in all its forms”. Rome (2024).
32. Madewell ZJ., et al. “Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia”. BMJ Global Health12 (2024): e017262.
33. Ahmed FN., et al. “Identifying the factors causing malnutrition and its impact on mortality among under-five Bangladeshi children”. Family Medicine and Primary Care Review 3 (2021): 255-260.
34. Atalell KA., et al. “Mapping underweight in children using data from the five Ethiopia Demographic and Health Survey data conducted between 2000 and 2019: A geospatial analysis using the Bayesian framework”. Frontiers in Nutrition 9 (2022): 988417.
35. United Nations Children’s Fund. “Ethiopia Annual Report” (2023).
36. Adedokun ST and Yaya S. “Factors associated with adverse nutritional status of children in sub-Saharan Africa: Evidence from the demographic and health surveys from 31 countries”. Maternal and Child Nutrition3 (2020): e13198.
37. Tafese Z., et al. “Child feeding practice and primary health care as major correlates of stunting and underweight among 6- to 23-month-old infants and young children in food-insecure households in Ethiopia”. Current Developments in Nutrition 9 (2020): nzaa137.
38. World Health Organization Department of Child and Adolescent Health and Development Department of Nutrition for Health and Development. Feeding the non-breastfed child 6-24 months of age (2004).
39. Wondim A., et al. “Major maternal related determinants of nonbreastfeeding among mothers in Ethiopia: A multilevel analysis from DHS Ethiopia 2016”. PLOS ONE6 (2023): e0286662.
40. Tesgara BB., et al. “Early termination of breast-feeding practice and associated factors among mothers of children under 2 years old in Asella Referral and Teaching Hospital”. Science Set Journal of Pediatrics2 (2024): 1-15.
41. Celik NM and Köksal E. “Application of the infant and young child feeding index and the evaluation of its relationship with nutritional status in 6-24 months children”. Brazilian Journal of Nutrition1 (2024).
42. Acquah E., et al. “Predictors of underweight in children under-five years in Ghana”. Ghana Medical Journal 1 (2019): 71-78.
43. Sewenet T W., et al. “Undernutrition and associated factors among children aged 6-23 months in Dessie town, Northeastern Ethiopia, 2021: A community based cross-sectional study”. Frontiers in Pediatrics 10 (2022): 916726.
44. Tebeje MT., et al. “Minimum meal frequency and associated factors among children aged 6-23 months in Sub-Saharan Africa: a multilevel analysis of the demographic and health survey data”. Frontiers in Public Health 12 (2024): 1468701.
45. “Comprehensive implementation plan on maternal, infant and young child nutrition” (2014).
46. Twabi HS., et al. “Evaluating the effect of appropriate complementary feeding practices on child growth in Malawi using cross-sectional data: an application of propensity score matching”. Frontiers in Nutrition 8 (2021): 714232.
47. Bong MW., et al. “Nutritional status and complementary feeding among Penan infants and young children in rural Sarawak, Malaysia”. Malaysian Journal of Nutrition4 (2018): 539-550.
48. Anin KS., et al. “Association between infant and young child feeding (IYCF) Indicators and the nutritional status of children (6-23 Months) in Northern Ghana”. Nutrients9 (2020): 2565.
49. Udoh EE and Amodu OK. “Complementary feeding practices among mothers and nutritional status of infants in Akpabuyo Area, Cross River State Nigeria”. Springerplus1 (2016): 2073.
50. Federal Ministry of Health Ethiopia. “National guideline for the management of acute malnutrition in Ethiopia” (2019).
51. Ethiopian Federal Ministry of Health (FMoH). “National standard definitions for sanitation hygiene and water” (2021).
52. Coates Jennifer., et al. “Household food insecurity access scale (HFIAS) for measurement of food access: indicator guide”. Washington, D.C.: FHI 360/FANTA (2007).
53. Shibeshi AH and Asfaw ZG. “The influence of minimum dietary diversity on undernutrition among children aged 6-23 months in Ethiopia: a multilevel mixed-effect analysis based on 2019 Ethiopian mini demographic and health survey”. Frontiers in Public Health 12 (2024): 1436683.
54. Tafese Z., et al. “Undernutrition and associated factors among children 6-23 months old in largely food insecure areas of rural Ethiopia”. Journal of Nutritional Science 11 (2022): e63.