DIETARY KNOWLEDGE, COMPLEMENTARY FEEDING PRACTICES AND NUTRITION STATUS OF CHILDREN 6–23 MONTHS OLD IN SIAYA COUNTY, KENYA

Abstract

Malnutrition remains a critical public health challenge in Kenya, particularly among children aged 6–23 months, despite WHO recommendations on optimal complementary feeding practices. The study assessed the dietary knowledge, complementary feeding practices, and nutritional status of children aged 6-23 months in Siaya County, Kenya, to identify predictors of malnutrition. The study employed an explanatory sequential mixed-methods design with a descriptive cross-sectional approach in Siaya County. Data were collected from 282 caregiver-child pairs involving children aged 6-23 months using structured questionnaires, focus group discussions, and anthropometric measurements. Anthropometric data were analyzed using ENA for SMART, while SPSS Version 26 facilitated chi-square tests and regression analysis to examine relationships and identify predictors of nutritional outcomes among the participants. The study revealed that while 70.21% of caregivers initiated complementary foods at the recommended age, between 6 and 8 months, significant gaps persisted in dietary quality. Only 36.52% achieved minimum dietary diversity (MDD; mean score: 4.93 ± 1.23), and 4.96% met minimum meal frequency (MMF). Despite high breastfeeding continuation rates (77.30%) and caregiver awareness (83.69%), 76.86% of children did not meet milk feeding frequency, and only 4.61% achieved a minimum acceptable diet (MAD). Diets relied heavily on grains/tubers (93.26%) and vitamin A-rich foods (81.91%), with a moderate intake of flesh foods (57.80%), legumes (49.29%), and eggs (36.52%), but low consumption of dairy products (10.64%). Nutritional status indicators showed stunting at 29.08%, underweight at 13.12%, and wasting at 4.96%, with girls experiencing higher stunting rates than boys (36.55% versus 21.17%). Regression analysis identified critical predictors: males had 36.6% lower odds of being underweight (OR = 0.634, p = 0.021) but 13-fold higher odds of being wasted (OR = 13.39, 95% CI: 1.73–103.83, p = 0.013). Early food introduction at 5-6 months increased the odds of stunting by 4.66-fold (OR = 4.66, p = 0.001). Protective factors included boiling drinking water (14.4% reduced wasting odds; OR = 0.856, p = 0.034) and frequent feeding. Caregiver knowledge significantly influenced feeding practices, with parents prioritizing food affordability over nutritional quality. Dietary diversity and MAD showed no significant predictive value for nutritional outcomes (p > 0.05). Caregiver knowledge, socio-economic constraints, and cultural practices significantly influenced complementary feeding practices. The study recommends strengthening caregiver education programs on dietary diversity and feeding frequency, as well as enhancing water, sanitation, and hygiene (WASH) practices, to mitigate malnutrition risks. These findings offer valuable insights for policymakers, health professionals, and practitioners implementing child survival programs in similar settings.