Complementary feeding practices and added sugar consumption among urban children aged 6-23 months in Kampala, Uganda: a cross-sectional study

Complementary feeding practices and added sugar consumption among urban children aged 6-23 months in Kampala, Uganda: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Complementary feeding practices and added sugar consumption among urban children aged 6-23 months in Kampala, Uganda: a cross-sectional study Catherine Lutalo Mwesigwa, Grace Sanyu Nabaggala, Maria-Goretti Nakyonyi, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5380882/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The World Health Organization has established key indicators to monitor infant and young child feeding practices globally, particularly in low- and middle-income countries. In urban areas, the nutrition transition from traditional diets has increased the consumption of ultra-processed foods/beverages and added sugar, raising concerns about their impact on children's diets and health. This study aimed to investigate complementary feeding practices, added sugar use, and sources of nutrition information among caregivers of young children in Kampala, Uganda. Methods This secondary analysis was conducted in August 2024, using data from a cross-sectional study conducted in 2021 on commercial baby food consumption among 6–36 month olds in Kampala, Uganda. For this analysis, 286 children aged 6–23 months were selected through systematic sampling. Data collection focused on eight WHO complementary and two breastfeeding indicators, sources of nutrition information, and added sugar consumption. Descriptive statistics and modified Poisson regression assessed associations to examine the association between socio-demographic factors and dietary indicators. Results The study included 286 children aged 6–23 months with a median age of 14 months. Nearly all caregivers reported that the children had ever breastfed since the birth, with 67.1% still breastfeeding at the time of the study. Added sugar consumption was high, with 89.9% of children consuming added sugars. Only 37.1% met the minimum dietary diversity, and 33.9% met the minimum acceptable diet. Higher maternal education and socio-economic status were associated with better dietary diversity and acceptable diet. Family and the internet were the most common sources of nutrition information. Conclusion Complementary feeding practices in urban Kampala reveal high breastfeeding rates but significant added sugar consumption and low dietary diversity. There is a need for policies and guidelines emphasising the quality of both commercial and home-prepared foods and addressing the consumption of ultra-processed foods and beverages. Nutritional education should leverage internet access to deliver tailored infant and young child feeding messages effectively. Improving complementary feeding practices can enhance children's nutritional outcomes and overall health in urban Uganda. This study underscores the importance of targeted interventions and policy measures to promote optimal feeding practices and improve the nutritional status of young children. Infant and young child feeding Complementary feeding Sugar consumption Urban nutrition transition Dietary diversity Nutritional education Ultra-processed foods Kampala Uganda BACKGROUND In recent years, there has been a growing emphasis on monitoring and improving infant and young child feeding (IYCF) practices globally guided by key indicators outlined by the World Health Organisation (WHO). These indicators serve as essential benchmarks for assessing the nutritional adequacy of young children's diets ( 1 , 2 ). Urban populations in low- and middle-income countries (LMICs) are undergoing a nutrition transition characterised by an increase in consumption of ultra-processed foods, including refined sugar, which has detrimental effects on both general and oral health. The transition from exclusive breastfeeding or breastmilk substitutes to other solid foods, known as complementary feeding, marks a critical period in an infant’s growth and development. Adequate nutrition during this stage is vital for optimal health outcomes and lays the foundation for lifelong well-being ( 3 ). To evaluate the adequacy of complementary feeding practices, the WHO has established several indicators including three core indicators: Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD) ( 2 ). While these indicators offer valuable insights into IYCF practices, their application extends beyond individual dietary components to encompass broader nutritional considerations. However, in the context of evolving dietary patterns and nutritional transitions, particularly evident in urban settings, the adequacy of infant and young child (IYC) diets faces new challenges. The proliferation of processed foods, including commercially available complementary foods, presents novel considerations for assessing dietary diversity and nutritional quality ( 3 , 4 ). While fortified commercial products may address specific nutrient deficiencies, their widespread consumption raises questions about the overall nutritional adequacy and appropriateness of these foods in IYC diets ( 5 , 6 ). Moreover, the increasing consumption of foods high in added sugars or the use of added sugar during preparation of foods, particularly among young children, poses significant health risks. Excessive sugar intake has been linked to various health detriments, including early childhood caries (ECC), and obesity, setting individuals on a trajectory of poor health starting early in childhood ( 7 , 8 ). Early exposure to high levels of added sugars not only increases the risk of developing health issues but also gets children accustomed to sweet tastes, potentially affecting their later food choices and dietary preferences ( 9 , 10 ). In Uganda, as in many LMICs, the prevalence of undernutrition coexists with emerging issues related to over-nutrition and nutrition-related non-communicable diseases (NR-NCDs) ( 11 ). Despite efforts to promote optimal IYCF practices, gaps remain in addressing the complexities of dietary transitions and the influence of processed foods on nutritional outcomes ( 12 ). Furthermore, the majority of published studies in Uganda have focussed on rural populations because of the propensity for research that focuses on vulnerable groups and undernutrition. Against this backdrop, this study investigated complementary feeding practices among urban/peri-urban children aged 6–23 months in Kampala, Uganda, as secondary analysis. Secondly, the study intended to document sugar use during the complementary period and finally the sources of nutrition information for the caregivers were assessed. By examining these aspects in the context of evolving dietary patterns, we aim to contribute to a deeper understanding of infant nutrition in urban settings and inform targeted interventions and policy measures to promote optimal feeding practices and improve nutritional outcomes for young children in Uganda. METHODS This was a cross sectional descriptive study involving secondary analysis in August 2024 of data collected in another study. The parent study was a cross-sectional descriptive study conducted from October to December 2021 whose major aim was to investigate commercial baby food use by caregivers among aged 6 to 36 month-olds attending selected health facilities in Kampala, the capital city of Uganda and comprised 410 pairs of children and caregivers. The parent study setting included a fully urbanised area and the neighbouring districts exhibiting urbanisation rates of 40–50% ( 13 ). The study targeted a heterogeneous population reflective of Kampala's diverse ethnic groups, with English serving as the official language of communication and Luganda being predominant among the indigenous population ( 14 ). Exclusion criteria were pairs with caregivers younger than 18 years, those with limited proficiency in English or Luganda and those whose children were severely ill. The current study included children aged 6–23 months Sample Size and Sampling For secondary analysis, the following formula for calculating survey proportions was used: Given a sample size n , statistical level of confidence Z, expected proportion P, and precision d: Z = 1.96 (95% confidence), P = 0.16, and d = 0.06, and using a prevalence of 16% of 6–23 months old with a minimum acceptable diet (MAD) in Kampala ( 15 ). Using these values, n = 142.9, approximately n = 143. To account for the design effect due to multi-stage cluster sampling, a factor of 2 was used, increasing the sample size to n = 286. Systematic sampling was used to select the study participants. Data collection A data abstraction tool was designed in English language. This tool was divided in three sections; - Section A: demographic characteristics (child and parental), Section B: maternal nutrition education characteristics and Section C: complementary feeding practices. The tool was pretested on a data base of children 24–36 months. Data for this study was then abstracted from the database of the previous study titled “Commercial baby food use among caregivers of children 6–36 months in urban/ peri-urban Kampala”. Study variables The outcome variables for this study were eight key WHO complementary feeding indicators and two breastfeeding indicators ( 2 ). The breastfeeding indicators included were “ever breastfed” and continued breast feeding. The complementary indicators were introduction of solids, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, flesh food/egg consumption, sweet beverage consumption, unhealthy food consumption, and zero vegetable/fruit consumption. The independent variables included socio-demographic characteristics and maternal attendance of nutritional class. For the other study objectives, the variables were; source of nutrition information and added sugar consumption. Data Management and Analysis Details of data management have been published ( 16 ). Since this was a secondary analysis, only bivariate analysis was done for the complementary indicators; MDD and MAD. Nearly all achieved MMF and therefore no statistical test was performed for MMF. The outcomes MAD and MDD for each child were binary (“Yes” or “No”) having achieved the minimum requirements for the indicator or not. The statistical test used was modified Poisson. RESULTS Socio-demographic characteristics of parents/caregivers and children aged 6–23 months A total of 286 children aged 6–23 months were included in the secondary analysis and these had equal proportions of males and females. 39.9% were infants (6–12 months) while the rest were young children (aged 13–23 months) with an overall median age of 14 months. Table 1 summarizes their socio-demographic characteristics. Most of the caregivers were mothers (95.5%, n = 273), among whom 86.8%, (n = 237/273). Six (2%) of the caregivers were fathers while the seven were other relatives (Table 1 ). Antenatal care attendance and nutrition education Among the 273 mothers interviewed, 87% (n = 237) reported having attended antenatal care (ANC) during pregnancy. Of those who attended ANC, 29.5% (n = 70/237) had attended an infant nutrition class. Almost all that attended ANC (97.1%, n = 67/69) had lessons on exclusive breastfeeding while only 29% (n = 20/69) reported having information on the use of other foods like processed foods for IYC feeding. Other than health facilities, the commonest child nutrition information sources among the caregivers were: family (61.1%, n = 165), friends (49.3%, n = 134) and the internet (49.6%, n = 133). Table 1 Socio-demographic characteristics of children and their parents among participants (N = 286) Variable n % Child characteristics Child’s sex (n = 286) Female Male 144 142 50.0 50.0 Child’s age in months (n = 286) 6–12(infants) 13–23 114 172 39.9 60.1 Relationship of caregiver Mother Father Other relative 273 6 7 95.5 2.1 2.4 Parental characteristics Parents’ marital status (n = 281) Married Unmarried 253 28 90.0 10.0 Maternal age (n = 278) ≤ 25 years 26–30 years 31–35 years ≥ 36 years 48 100 83 47 17.2 35.6 29.9 16.9 Maternal education level (n = 278) None/primary level O’ level completed A’ level/Tertiary College/University 29 42 43 164 10.4 15.1 15.5 59.0 Paternal occupation (n = 249) Unemployed Business Skilled, sales, services Professional 15 70 28 136 6.0 28.1 11.2 54.6 Paternal education level (n = 250) O’ level or less completed A’ level/Tertiary College/University 45 27 178 18.0 10.8 71.2 Parental income (n = 205) Irregular Regular 24 181 11.7 88.3 Household characteristics SES (n = 275) 1st lowest 2nd middle 3rd highest 93 99 83 33.8 36.0 30.2 SES was derived from a principal component analysis of home ownership, floor type, fuel type, toilet type, and land ownership with initial categorisation similar to those used to describe household characteristics by Uganda National Bureau of Statistics(UNBS) in demographic Health surveys (a. Uganda Bureau of Statistics (UBOS) & ICF., 2018). Table 2 Maternal health care and nutritional education-related characteristics for 6–23 months children who attended selected health facilities in Kampala, (n = 273*) Variable n % Mother ever attended antenatal care (ANC) (n = 273) No Yes 36 237 13.2 86.8 Mother ever attended a nutritional class during ANC (n = 237) No Yes 167 70 70.5 29.5 Ever had exclusive breastfeeding counsel (n = 69) No Yes 2 67 2.9 97.1 Source of nutritional information(Yes) Family (n = 270) Friends (n = 272) Social media (n = 266) Magazine (271) Television (n = 268) Internet (n = 268) 165 134 103 28 89 133 61.1 49.3 38.7 10.3 33.2 49.6 *Only 273 mothers were interviewed. The others were other caregivers Complementary feeding practices and sugar use Nearly all caregivers (97.6%, n = 279/286) reported that the children had at least have ever breastfed since birth. However, at the time of the study, the proportion of children still breastfeeding had reduced to 68% (n = 198). Among those aged 6–8 months, 69% were feeding on semi-solid/solid food. Within the last 24 hours, 57.3% (n = 164) consumed flesh or egg. Regarding unhealthy feeding practice indicators, 39.5% (n = 113) did not eat any vegetables or fruit the day before, 38% and 37% had consumed sugar-sweetened beverages and unhealthy foods. When combined 71% had consumed at least one unhealthy food or beverage. In addition, 90% (n = 257) of the children consumed sugar in either porridge or homemade juice (Table 3 ). Consumption of at least one traditional home-prepared meal within 24 hours was 92% (n = 263), while the rest, 8% (n = 23) consumed only unhealthy foods and beverages. Those that consumed at least one porridge meal 61%. Table 3 Breastfeeding, complementary indicators and added sugar consumption among 6-23-month old children that attended the selected health facilities in Kampala (n = 286) Characteristic Total Yes % ^Ever breastfed 286 279 97.6 ^Continued breastfeeding (6–23 months) 286 198 68.0 ^Solid/semi-solid foods (6–8 months) 48 33 68.8 ^Egg and/or flesh© consumption (6–23 months) 286 164 57.3 ^Zero vegetable or fresh fruit consumption (6–23 months) 286 113* 39.5** ^Sweet beverage consumption 286 102 35.7 ^Unhealthy food consumption 286 107 37.4 Total unhealthy food &beverage consumption 286 153 71.0 Consumption of added sugar 286 257 89.9 ^ Calculated based on WHO infant and young child feeding indicators (WHO & UNICEF, 2021) * * * * “No” consumption **Percentage of no consumption ©Flesh foods include meat, fish, poultry, organic meats Minimum infant and young child feeding practices Overall, just over a third (37.1%, n = 106) met the minimum dietary diversity (MDD), nearly all (97.2%, n = 278) met the minimum meal frequency (MMF), while about a third (33.9%, n = 97) met the minimum acceptable diet (MAD). However, 30.4% (n = 87) of the children consumed ultra-processed foods and did not meet the MAD. Table 4 summarises the percentage of children meeting the minimal complementary feeding indicators. Table 4 Percentage of children 6–23 months of age meeting MDD, MMF and MAD indicators (n = 286) Indicator Overall n (%) Categories Minimum dietary diversity, %† 106 (37.1) 6–12 months (n = 114) 36 (31.6) 13–23 months (n = 172) 70 (40.7) Minimum meal frequency %‡ 278 (97.2) 6–8 months (n = 48) 45 (93.8) 9–23 months (n = 238) 233 (97.9) Minimum acceptable diet % $ 97 (33.9) Non-breastfed (n = 94) 16 (17.0) Breastfed (n = 192) 81 (42.2) All calculations were based on WHO infant and young child feeding indicators †minimum dietary diversity was defined as consumption of at least five out of eight food categories by 6–23 months old, including breastfeeding as a meal. ‡ Calculated based on World Health Organisation infant and young child feeding indicators; minimum meal frequency was defined as at least two times for breastfed children 6–8 months, at least three times for children 9–23 months and at least four times for non-breastfed children 6–23 month. $ The minimum acceptable diet is defined as •for breastfed children: receiving at least the minimum dietary diversity and minimum meal frequency for their age during the previous day; •for non-breastfed children: receiving at least the minimum dietary diversity and minimum meal frequency for their age during the previous day as well as at least two milk feeds (WHO & UNICEF, 2021). Table 5 Bivariate analysis of the association between complementary feeding indicators (MDD and MAD) and socio-demographic characteristics among 6-23-month old children in Kampala (n = 286) Variable overall MDD PR, 95% CI, p-value MAD PR, 95% CI, p-value Child sex Female Male Ref 1.32, 0.97–1.80, 0.074 Ref 1.44, 1.04–2.01, 0.030* Child’s age in months (n = 286) 6–12(infants) 13–23 Ref 1.29, 0.93–1.78, 0.127 Ref 1.23, 0,87-1.73, 0.242 Maternal education level (n = 278) No education/primary level completed O levels completed A level/Technical/Vocational completed College/University completed Ref 2.99, 0.93–9.59, 0.065 3.60, 1.48–11.26, 0.028* 4.24, 1.43–12.28, 0.009* Ref 0.92, 0.83-1.0, 0.076 0.88, 0.80–0.98, 0.017* 0.84, 0.78–0.90,<0.001* Maternal age (n = 278) ≤ 25 years 26–30 years 31–35 years ≥ 36 years Ref 1.80, 1.05–3.08, 0.032* 1.20, 0.66–2.17, 0.536 1.87, 1.05–3.34, 0.033* Ref 0.90, 0.83–1.01, 0.076 0.97, 0.88–1.06, 0.444 0.89, 0.79–0.99, 0.040* Socioeconomic status (n = 275) 1st (lowest) 2nd (middle) 3rd (highest) Ref 1.72,1.14–2.59,0.009* 1.63,1.06–2.51,0.024* Ref 0.89, 0.82–0.96, 0.003* 0.91, 0.84–0.99, 0.022* Mother attended nutritional class (n = 237 ) No Yes Ref 0.92, 0.63–1.32, 0.647 Ref 1.03, 0.96–1.12, 0.393 Ref is the baseline comparative group whose adjusted PR is “1”. *p-value < 0.05 The data in Table 5 shows that children from families with middle and high socio-economic scores (SES) were more likely to meet MDD and therefore also meet the MAD requirements than those from low SES. Maternal education was positively associated with achieving both MDD and MAD, with the highest two levels significant for MDD. Females were 1.4 times more likely to meet MAD than makes. DISCUSSION Breastfeeding practices and sugar use The present study sought to establish key complementary feeding practices as defined by WHO and the sugar consumption of an urban population. Nearly all mothers in the present study reported ever breastfeeding their children similar to the national reports ( 15 ) and other countries like Tanzania where 99.7% of 0-23-month children had ever breastfed. However, these proportions are generally higher than in other SSA countries ( 17 ). As expected, the percentage of breastfeeding children dropped as they grew older. At the time of the study, more than two thirds were still breastfeeding, a higher proportion than the SSA average (54%) from 32 countries ( 17 ), and the Uganda national rate (43.2%) among 6–23 months old ( 15 ). Higher breastfeeding rates suggest the urban population is more responsive to educational messages due to aggressive breastfeeding campaigns supported by the Ugandan IYCF policy ( 18 , 19 ). Longer breastfeeding duration might also result from greater exposure to family planning messages and access to contraceptives, increasing the interval between births ( 20 ), compared to the rest of the national population ( 21 ). Despite higher breastfeeding rates, efforts are needed to strengthen policies supporting exclusive breastfeeding for the first six months and continued breastfeeding for at least two years, as recommended by WHO ( 22 , 23 ). It is concerning that 90% of the children consumed sugar or honey in their drinks, including cereal porridge, tea, and homemade juice. This habit is common in the Ugandan urban setting and other African and Asian urban populations (Nepal, Indonesia, Tanzania, and Senegal), where consumption levels ranged from 23–80% among 6–23 months old. However, the African cities; Dar-es-Salaam and Dakar had higher sugar consumption than Asian cities ( 24 ), suggesting that adding sugar to children's drinks might be a more common feeding practice in Africa. Adding sweeteners to drinks at home should be discouraged, and guidelines on appropriate amounts should be provided. Studies have shown that there is no nutritional requirement for free or added sugars, as demonstrated in children with fructose intolerance who had favourable health outcomes when sugar intakes were eliminated ( 25 ). Instead, free sugars provide significant energy without specific nutrients ( 26 ). Due to such concerns, the WHO provided evidenced guidelines for free sugar consumption to be limited to 10% of the total energy intake to prevent (NR-NCDs) and preferably a further reduction to less than 5% for dental health ( 27 ). Since children from all age groups consumed added sugar, it highlights the minimal nutritional education on sugar in IYC feeding in this urban population. Findings from Burkina Faso indicated that increasing the sweetness of porridge led to increased consumption ( 28 ). Consuming high quantities of gruels at the expense of nutrient-rich foods compromises nutrient intake, as gruels are energy-dense but nutrient-poor ( 29 ). This reveals risks for poor dental health and early preference for sweet tastes. Additionally, honey is not recommended for infants due to the risk of Clostridium botulinum toxins, which can cause botulism ( 30 ). Minimal complementary feeding indicators The percentage of 6-8-month-old infants who fed on semi-solid/solid foods (69%) was similar to the SSA average ( 17 ) but lower than the national estimate (81%) ( 15 ) and other SSA countries like Tanzania, Congo Republic, and Mozambique (> 90%) ( 17 ). These findings indicate many urban children experience suboptimal diets at an age when their bodies need the most energy from foods other than breast milk, which becomes insufficient by six months ( 22 , 31 , 32 ). The findings indicate that 37% of children met the MDD, comparable to the national (30%) and Kampala (39%) estimates. The MMF was more than twice the national estimates (41%) estimates and higher than the Kampala estimates (67%). This could due to this study’s definition of MMF based on the latest guidelines ( 2 ). The MMF definition in the 2016 UDHS ( 1 ) has changed from considering four milk feeds for non-breastfed children to including at least one semi-solid non-milk feeding ( 2 ) which can significantly boost the current MMF score. Given that most children took porridge and overall eight tenths ate at least one local meal, meeting the MMF is achievable for this urban population. Furthermore, ( 36 )a high MMF could also be due to the higher wealth percentile of participants compared to UDHS ( 15 ). The urban population scored positively on homeownership, floor type, fuel type, toilet type, and land ownership, indicators of wealth and socio-economic status. Higher wealth percentile scores predict IYC nutrition indicators in Uganda ( 33 ). Despite a high MMF, the low MDD indicates that the majority of the 6-23-month-old children's diets were micronutrient-poor and of poor quality. The high consumption of unhealthy foods and sweet beverages could explain this. For example, “milk feeds” composed of sweetened yogurts and sweetened milk, although fulfilling MMF and MDD criteria, are ultra-processed and thus questionable for IYC. Therefore, when the Ugandan IYC guidelines are being updated, it is vital to acknowledge the heterogeneity of populations in feeding patterns across different regions ( 34 )., including those with access to and who can afford commercial ultra-processed foods/beverages. For such scenarios, emphasis should be put on aspects that cover the quality of these products while being contextually specific and relevant to these population differences ( 35 ). The national (15%) and Kampala (16%) MAD estimates were half the MAD in this study ( 15 ). The significantly high MMF might explain the MAD variance between surveys which UDHS might not emphasise using the older guidelines. UDHS likely focuses on traditional home-prepared foods, important in rural areas, while urban settings include substantial commercial food consumption some of which are ultra-processed. Therefore, in future surveys, UDHS should include the new indicators for unhealthy foods and beverages ( 2 ), and especially for urban areas experiencing nutrition transitions. Comparisons of the three indicators between this study and the last UDHS are not ideal, especially for minimum complementary indicators, as previous studies used different WHO definitions ( 1 ). The recent WHO updates emphasise breastfeeding in the MDD and changes to the MMF definition which in turn affect the MAD indicator in the latest definitions ( 2 ). The subgroups of big concern include those that did not consume home-prepared foods or semi-solids/solids who risk malnutrition by replacing micronutrient-rich local foods with nutrient-poor unhealthy foods and beverages ( 36 ). For example several failed to meet the MAD including non-consumption of meat or eggs, vegetables or fruits. This reflects early-life nutrition transition in urban populations, with lower vegetable and fruit consumption replaced by sugary beverages ( 11 , 37 ). The three indicators—MDD, MMF, and MAD—are effective proxies for assessing feeding practices, including ultra-processed food and beverage consumption (UPFB), as shown in this study. Including UPFB provides additional information on the vulnerability of subpopulations ( 2 ). Therefore, future studies in LMIC should include measures on unhealthy UPFB consumption to evaluate IYC feeding practices comprehensively. Unfortunately, there are few published SSA studies on this topic, covering only two urban African populations ( 6 , 38 , 39 ), making comparisons challenging. When examining socio-demographic factors, maternal education and higher socio-economic status were positively associated with MDD and MAD, as seen in UDHS findings ( 15 , 33 ) and this has been also been linked to healthier dietary patterns ( 40 ). Maternal education aids in acquiring IYCF knowledge, while higher socio-economic status allows access to diverse, healthy foods ( 40 ). LMIC studies suggest these factors empower women, aiding in child feeding decisions ( 41 ). Unexpectedly, attending a nutritional class was not significantly associated with MDD or MAD. Nutritional counselling, effective in improving malnourished children's nutritional status ( 42 ), might require repeated exposure to consistent IYCF messages. One-off or unstructured interactions at health facilities may not be as effective. A Kenyan study found that mothers exposed to IYCF messages 3–4 times had better knowledge (p = 0.01) and attitude scores (p = 0.08) than those exposed only once ( 43 ) suggesting the need for structured nutritional education with repeated exposure ( 19 ). Source of nutritional information The survey for mothers included questions about their access to and sources of nutritional information. “Family” was the most common source, while nearly half sought information from the internet and friends. Surprisingly, fewer mothers accessed nutritional information from health facilities during ante-natal care. These findings suggest that nutritional education should adopt a population-wide approach, reaching as many people and cultures as possible. Messages should be updated to include information on UPFB and tailored to local evidence from different regions. Given many mothers have internet access, this should be leveraged with contextual messages on IYCF and maternal nutrition. The latest framework on maternal, infant, young child, and adolescent nutrition ( 19 ) does not recognise this strategy. However, for literate, educated populations with internet access, this could be a cost-effective way of delivering messages across different age groups. CONCLUSION This study highlights significant insights into complementary feeding practices, sugar consumption, and sources of nutrition information among caregivers in urban Kampala, Uganda. High breastfeeding rates were noted, but there was significant sugar consumption and low dietary diversity among children. Higher maternal education and socio-economic status correlated with better dietary outcomes. Breastfeeding practices in this population were acceptable ( 17 ), but complementary practices were deficient. Policies should shift focus from only exclusive breastfeeding and timing of introducing complementary foods to the quality of both processed and home-prepared foods. Current guidelines inadequately address processed foods, assuming the population relies solely on traditional homemade foods. Many children consumed unhealthy foods and beverages and yet did not meet MDD. Ultra-processed foods like sweetened flavoured yoghurt, lack nutritive value and should not count towards MDD, but current guidelines do not address this ( 2 ). Guidelines should specify excluding nutritionally poor foods from MMF and MDD indicators, while providing contextually appropriate descriptions. Furthermore, the widespread use of sugar emphasises the need for targeted policies to improve the nutritional quality of children’s diets. Nutritional education should utilise the internet and other key sources of information to disseminate evidence-based IYCF practices. Future research should include longitudinal methods and comprehensive assessments of nutritional and health indicators, such as stunting, wasting, overweight, and dental caries. Additionally, understanding the socio-economic and cultural factors influencing feeding practices is crucial for effective interventions. Improving complementary feeding practices in urban Kampala can enhance children’s nutritional outcomes and overall health, underscoring the need for continuous monitoring and targeted, inclusive policies. Limitations This study has several limitations that must be considered when interpreting the findings. Firstly, this was a secondary analysis and as a result, we were unable to perform a multivariate analysis to examine the associations between different socio-demographic factors and the IYCF indicators because of limited power calculations. This limitation restricts our ability to control for potential confounding variables and to fully explore the complex relationships between these factors and the feeding practices observed. The data on feeding practices and dietary intake were self-reported by caregivers, which may introduce recall bias and social desirability bias. Caregivers might over report or underreport certain behaviours, such as breastfeeding duration or the frequency of sugar consumption, to align with perceived desirable practices. Additionally, while the 24-hour dietary recall method provides valuable insights into recent feeding practices, it may not accurately reflect usual dietary intake over time. A single day’s intake may not capture variations in the child's diet, and more comprehensive dietary assessment methods would provide a fuller picture of nutritional adequacy. Additionally, key nutritional status indicators such as stunting, wasting, overweight and obesity, and dental caries were not collected, which would have given a more comprehensive assessment. Abbreviations · ANC - Antenatal Care · ECC - Early Childhood Caries · IYCF - Infant and Young Child Feeding · LMICs - Low- and Middle-Income Countries · MAD - Minimum Acceptable Diet · MDD - Minimum Dietary Diversity · NR-NCDs - Nutrition-Related Non-Communicable Diseases · SES - Socioeconomic Status · UBOS - Uganda Bureau of Statistics · UPFB - Ultra-Processed Foods and Beverages · WHO - World Health Organisation Declarations Ethics approval and consent to participate The parent study protocol received ethical approvals from the Makerere University's School of Health Sciences Higher Degrees (Ethics Reference No. MAKSHSREC-2021-138) and Research Ethics Committee, and the Uganda National Council of Science and Technology (Research registration No. HS1784ES). All participants provided written consent before data collection, with participation being voluntary and the option to withdraw at any stage. Permission was also obtained from health facility administrations to conduct the research on their premises. The survey was conducted anonymously to ensure privacy and confidentiality. When caregivers were not relatives, consent was obtained from both parents and the caregiver. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests Funding The work was supported by the Fogarty International Center of the National Institutes of Health, U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and President's Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Author Contribution C.L.M and S.N conceived and refined the research idea, drafted the initial proposal, and were involved in the whole research process till drafting of the manuscript. The co-authors B.N, D.K, M.G.N and A.M.K contributed to the drafting of the manuscript. G.S.N was involved in developing the research tool, collecting the primary data, analysing the data, and reviewed the drafted manuscript. All co-authors gave the final approval of the version to be published. Acknowledgement The following people are acknowledged for their tremendous contribution towards the study: Ms Prisca Kusasira, Ms Madina Nadduli during the extensive primary data collection. Data Availability The data sets supporting the conclusions of this article are available and can be obtained from the corresponding author upon reasonable request. References WHO, UNICEF. Indicators for assessing infant and young child feeding practices part 1: definitions. In. Geneva: WHO; 2008. WHO, UNICEF. 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Consumption of commercially produced snack foods and sugar-sweetened beverages during the complementary feeding period in four African and Asian urban contexts. Matern Child Nutr. 2017;13:e12412. https://doi.org/10.1111/mcn.12412 . Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(4):1084–102. https://doi.org/10.3945/ajcn.113.058362 . Sheiham A, James W. Diet and dental caries: the pivotal role of free sugars reemphasized. J Dent Res. 2015;94(10):1341–7. https://doi.org/10.1177/0022034515590377 . Skinner JD, Carruth BR, Bounds W, Ziegler PJ. Children's food preferences: a longitudinal analysis. J Am Diet Assoc. 2002;102(11):1638–47. https://doi.org/10.1016/S0002-8223(02)90349-4 . Ventura AK, Mennella JA. Innate and learned preferences for sweet taste during childhood. Curr Opin Clin Nutr Metab Care. 2011;14(4):379–84. 10.1097/MCO.0b013e328346df65 . Steyn NP, McHiza ZJ. Obesity and the nutrition transition in Sub-Saharan Africa. Ann NY Acad Sci. 2014;1311:88–101. https://doi.org/10.1111/nyas.12433 . Namugumya BS, Candel JJ, Talsma EF, Termeer CJ. Towards concerted government efforts? Assessing nutrition policy integration in Uganda. Food Secur. 2020;1–14. https://doi.org/10.1007/s12571-020-01010-5 . Uganda Bureau of Statistics (UBOS): National Population and Housing Census 2014 Final Results Report. In, Kampala. Uganda; 2016. Kampala City Council Authorirty (KCCA), UBOS: Kampala City Statistical Abstract. 2019. In. Kampala, Uganda: KCCA 2019. Uganda Bureau of Statistics (UBOS). In: Kampala, editor. The DHS Program (ICF): Uganda Demographic and Health Survey 2016. Maryland,USA: Uganda and Rockville; 2018. Mwesigwa CL, Naidoo S. Consumption frequency of ultra-processed foods and beverages among 6-to 36-month-olds in Kampala, Uganda. Matern Child Nutr2024:e13724. https://doi.org/10.1111/mcn.13724 Gebremedhin S. Core and optional infant and young child feeding indicators in Sub-Saharan Africa: a cross-sectional study. BMJ Open. 2019;9(2):e023238. https://doi.org/10.1136/bmjopen-2018-023238 . Mangasaryan N, Martin L, Brownlee A, Ogunlade A, Rudert C, Cai X. Breastfeeding Promotion, Support and Protection: Review of Six Country Programmes. Nutrients. 2012;4(8):990–1014. https://doi.org/10.3390/nu4080990 . Uganda Ministry of Health. Guidelines on maternal, infant, young child and adolescent nutrition. In. Kampala, Uganda: Ministry of Health; 2021. Bbaale E. Determinants of early initiation, exclusiveness, and duration of breastfeeding in Uganda. J Health Popul Nutr. 2014;32(2):249–60. Uganda Bureau of. In: Kampala, editor. Statistics (UBOS) a, ICF. TDP: Uganda National Household Survey 2016. Uganda Uganda Bureau of Statistics; 2018. PAHO, WHO. Guiding principles for the complementary feeding of the breast-fed child. In. Geneva: WHO; 2003. UNICEF. The International Code of Marketing of Breastmilk Substitutes. Baby Friendly Initiative. In.; 2018. Pries A, Huffman SL, Adhikary I, Upreti SR, Dhungel S, Champeny M, Zehner E. High consumption of commercial food products among children less than 24 months of age and product promotion in Kathmandu Valley, Nepal. Matern Child Nutr. 2016;12:22–37. https://doi.org/10.1111/mcn.12267 . Sheiham A, James WPT. A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health. 2014;14(1):1–8. 10.1186/1471-2458-14-863 . WHO, FAO: Diet, nutrition and the prevention of chronic diseasess: report of a joint WHO/FAO expert consultation. In: WHO Technical Report Series. vol. 916. World Health Organisation: World Health Organisation. 2003: 1-149. WHO. Guideline: sugars intake for adults and children. Geneva: World Health Organization; 2015. Vieu TT, Serge Trèche M-C. Effects of energy density and sweetness of gruels on Burkinabe infant energy intakes in free living conditions. Int J Food Sci Nutr. 2001;52(3):213–8. https://doi.org/10.1080/09637480020027000-3-4 . Dewey KG, Brown KH. Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs. Food Nutr Bull. 2003;24(1):5–28. https://doi.org/10.1177/156482650302400102 . Van Der Merwe J, Kluyts M, Bowley N, Marais D. Optimizing the introduction of complementary foods in the infant's diet: a unique challenge in developing countries. Matern Child Nutr. 2007;3(4):259–70. https://doi.org/10.1111/j.1740-8709.2007.00111.x . Pries A, Huffman SL, Mengkheang K, Kroeun H, Champeny M, Roberts M, Zehner E. High use of commercial food products among infants and young children and promotions for these products in Cambodia. Matern Child Nutr. 2016;12(S2):52–63. https://doi.org/10.1111/j.1740-8709.2007.00111.x . WHO. Guiding principles for feeding non-breastfed children 6–24 months of age. In. Geneva: World Health Organisation; 2005. Ickes SB, Hurst TE, Flax VL. Maternal literacy, facility birth, and education are positively associated with better infant and young child feeding practices and nutritional status among Ugandan children. J Nutr. 2015;145(11):2578–86. https://doi.org/10.3945/jn.115.214346 . Batalha MA, França AKTC, Conceição SIO, Santos AM, Silva FS, Padilha LL, Silva AAM. Processed and ultra-processed food consumption among children aged 13 to 35 months and associated factors. Cadernos de saude publica. 2017;33. https://doi.org/10.1590/0102-311X00152016 . WHO. Ending inappropriate promotion of commercially available complementary foods for infants and young children between 6 and 36 months in Europe. In. Edited by World Health Organisation. Copenhagen, Denmark: World Health Organization; 2019. Pries AM, Rehman AM, Filteau S, Sharma N, Upadhyay A, Ferguson EL. Unhealthy snack food and beverage consumption is associated with lower dietary adequacy and length-for-age z-scores among 12–23-month-olds in Kathmandu Valley, Nepal. J Nutr. 2019;149(10):1843–51. https://doi.org/10.1093/jn/nxz140 . Popkin BM. Synthesis and implications: China's nutrition transition in the context of changes across other low-and middle‐income countries. Obes Rev. 2014;15:60–7. https://doi.org/10.1111/obr.12120 . Feeley AB, Ndeye Coly A, Sy Gueye NY, Diop EI, Pries AM, Champeny M, Zehner ER, Huffman SL. Promotion and consumption of commercially produced foods among children: Situation analysis in an urban setting in Senegal. Matern Child Nutr. 2016;12:64–76. https://doi.org/10.1111/mcn.12304 . Vitta BS, Benjamin M, Pries AM, Champeny M, Zehner E, Huffman SL. Infant and young child feeding practices among children under 2 years of age and maternal exposure to infant and young child feeding messages and promotions in Dar es Salaam, Tanzania. Matern Child Nutr. 2016;12:77–90. https://doi.org/10.1111/mcn.12292 . Claudia G-C, Lucia M-S, Miguel K-K, Patricia C, Edgar D-G. Association between sociodemographic factors and dietary patterns in children under 24 months of age: a systematic review. Nutrients. 2019;11(9):2006. https://doi.org/10.3390/nu11092006 . Has EMM, Efendi F, Wahyuni SD, Mahmudah IZ, Chotimah K. Women’s empowerment and socio demographic characteristics as determinant of infant and young child feeding practice in Indonesia. Curr Res Nutr Food Sci. 2022;10(2):607–19. https://dx.doi.org/10.12944/CRNFSJ.10.2.17 . Imdad A, Yakoob MY, Bhutta ZA. Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries. BMC Public Health. 2011;11(3):S25. https://doi.org/10.1186/1471-2458-11-S3-S25 . Schneider L, Kosola M, Uusimäki K, Ollila S, Lubeka C, Kimiywe J, Mutanen M. Mothers’ perceptions on and learning from infant and young child-feeding videos displayed in Mother and Child Health Centers in Kenya: a qualitative and quantitative approach. Public Health Nutr. 2021;24(12):3845–58. https://doi.org/10.1017/S1368980021002342 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5380882","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":373694132,"identity":"d8b0915b-6cda-4115-a6db-362701def5ef","order_by":0,"name":"Catherine Lutalo Mwesigwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYJACZgaGfwb8IFZCAXE6GJsZGA4YSDaAtBiQosXgAIhNjBbd9sPPHxe23TE2Pr868cMDAwZ5frED+LWYnUkzbJ7Z9szM7MbbzRJAhxnOnJ1AQMsNBsNm3jZmG7MbZzeAtCQY3Caohf0jWIvxjLObfxCphQdky2EzA/7ebUTaciancDbPuTRjiRu82ywSDCSI8Mvx4xs+85TZGPb3n91880eFjTy/NAEtYMDIBiQkwColiFAOBn+AmP8AsapHwSgYBaNgpAEAJ3hHsCaA+XYAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"Catherine","middleName":"Lutalo","lastName":"Mwesigwa","suffix":""},{"id":373694133,"identity":"db7e157f-459f-4a72-94a6-05475676ae85","order_by":1,"name":"Grace Sanyu Nabaggala","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Grace","middleName":"Sanyu","lastName":"Nabaggala","suffix":""},{"id":373694134,"identity":"edf61f4d-87ba-4266-a7be-0f951a9610aa","order_by":2,"name":"Maria-Goretti Nakyonyi","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Maria-Goretti","middleName":"","lastName":"Nakyonyi","suffix":""},{"id":373694135,"identity":"ecfec415-814c-4c70-a08f-520a09b4e6a6","order_by":3,"name":"Barbara Ndagire","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Ndagire","suffix":""},{"id":373694136,"identity":"494f1fc8-94e3-4b62-b10c-571e3894e148","order_by":4,"name":"Dunstan Kalanzi","email":"","orcid":"","institution":"New York University College of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Dunstan","middleName":"","lastName":"Kalanzi","suffix":""},{"id":373694137,"identity":"f5c803e8-cc2b-4f33-ab00-be9227076efa","order_by":5,"name":"Annet M. Kutesa","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Annet","middleName":"M.","lastName":"Kutesa","suffix":""},{"id":373694138,"identity":"ac0ed8e6-7006-406f-ab77-af06277e91b4","order_by":6,"name":"Sudeshni Naidoo","email":"","orcid":"","institution":"University of the Western Cape","correspondingAuthor":false,"prefix":"","firstName":"Sudeshni","middleName":"","lastName":"Naidoo","suffix":""}],"badges":[],"createdAt":"2024-11-03 07:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5380882/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5380882/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68984453,"identity":"bec1c146-a2c7-4642-9f4c-37574d380490","added_by":"auto","created_at":"2024-11-14 08:09:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1008304,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5380882/v1/e12b46c8-a6b5-47ca-a2a9-3bb461499a25.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Complementary feeding practices and added sugar consumption among urban children aged 6-23 months in Kampala, Uganda: a cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eIn recent years, there has been a growing emphasis on monitoring and improving infant and young child feeding (IYCF) practices globally guided by key indicators outlined by the World Health Organisation (WHO). These indicators serve as essential benchmarks for assessing the nutritional adequacy of young children's diets (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Urban populations in low- and middle-income countries (LMICs) are undergoing a nutrition transition characterised by an increase in consumption of ultra-processed foods, including refined sugar, which has detrimental effects on both general and oral health.\u003c/p\u003e \u003cp\u003eThe transition from exclusive breastfeeding or breastmilk substitutes to other solid foods, known as complementary feeding, marks a critical period in an infant\u0026rsquo;s growth and development. Adequate nutrition during this stage is vital for optimal health outcomes and lays the foundation for lifelong well-being (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). To evaluate the adequacy of complementary feeding practices, the WHO has established several indicators including three core indicators: Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile these indicators offer valuable insights into IYCF practices, their application extends beyond individual dietary components to encompass broader nutritional considerations. However, in the context of evolving dietary patterns and nutritional transitions, particularly evident in urban settings, the adequacy of infant and young child (IYC) diets faces new challenges. The proliferation of processed foods, including commercially available complementary foods, presents novel considerations for assessing dietary diversity and nutritional quality (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While fortified commercial products may address specific nutrient deficiencies, their widespread consumption raises questions about the overall nutritional adequacy and appropriateness of these foods in IYC diets (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, the increasing consumption of foods high in added sugars or the use of added sugar during preparation of foods, particularly among young children, poses significant health risks. Excessive sugar intake has been linked to various health detriments, including early childhood caries (ECC), and obesity, setting individuals on a trajectory of poor health starting early in childhood (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Early exposure to high levels of added sugars not only increases the risk of developing health issues but also gets children accustomed to sweet tastes, potentially affecting their later food choices and dietary preferences (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, as in many LMICs, the prevalence of undernutrition coexists with emerging issues related to over-nutrition and nutrition-related non-communicable diseases (NR-NCDs) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Despite efforts to promote optimal IYCF practices, gaps remain in addressing the complexities of dietary transitions and the influence of processed foods on nutritional outcomes (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Furthermore, the majority of published studies in Uganda have focussed on rural populations because of the propensity for research that focuses on vulnerable groups and undernutrition.\u003c/p\u003e \u003cp\u003eAgainst this backdrop, this study investigated complementary feeding practices among urban/peri-urban children aged 6\u0026ndash;23 months in Kampala, Uganda, as secondary analysis. Secondly, the study intended to document sugar use during the complementary period and finally the sources of nutrition information for the caregivers were assessed. By examining these aspects in the context of evolving dietary patterns, we aim to contribute to a deeper understanding of infant nutrition in urban settings and inform targeted interventions and policy measures to promote optimal feeding practices and improve nutritional outcomes for young children in Uganda.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis was a cross sectional descriptive study involving secondary analysis in August 2024 of data collected in another study. The parent study was a cross-sectional descriptive study conducted from October to December 2021 whose major aim was to investigate commercial baby food use by caregivers among aged 6 to 36 month-olds attending selected health facilities in Kampala, the capital city of Uganda and comprised 410 pairs of children and caregivers. The parent study setting included a fully urbanised area and the neighbouring districts exhibiting urbanisation rates of 40\u0026ndash;50% (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). The study targeted a heterogeneous population reflective of Kampala\u0026apos;s diverse ethnic groups, with English serving as the official language of communication and Luganda being predominant among the indigenous population (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). Exclusion criteria were pairs with caregivers younger than 18 years, those with limited proficiency in English or Luganda and those whose children were severely ill. The current study included children aged 6\u0026ndash;23 months\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Size and Sampling\u003c/h2\u003e\n \u003cp\u003eFor secondary analysis, the following formula for calculating survey proportions was used:\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n \u003cp\u003eGiven a sample size \u003cstrong\u003en\u003c/strong\u003e, statistical level of confidence Z, expected proportion P, and precision d: Z\u0026thinsp;=\u0026thinsp;1.96 (95% confidence), P\u0026thinsp;=\u0026thinsp;0.16, and d\u0026thinsp;=\u0026thinsp;0.06, and using a prevalence of 16% of 6\u0026ndash;23 months old with a minimum acceptable diet (MAD) in Kampala (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e). Using these values, n\u0026thinsp;=\u0026thinsp;142.9, approximately n\u0026thinsp;=\u0026thinsp;143. To account for the design effect due to multi-stage cluster sampling, a factor of 2 was used, increasing the sample size to \u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;=\u0026thinsp;286. Systematic sampling was used to select the study participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eA data abstraction tool was designed in English language. This tool was divided in three sections; - Section A: demographic characteristics (child and parental), Section B: maternal nutrition education characteristics and Section C: complementary feeding practices. The tool was pretested on a data base of children 24\u0026ndash;36 months. Data for this study was then abstracted from the database of the previous study titled \u0026ldquo;Commercial baby food use among caregivers of children 6\u0026ndash;36 months in urban/ peri-urban Kampala\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcome variables for this study were eight key WHO complementary feeding indicators and two breastfeeding indicators (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). The breastfeeding indicators included were \u0026ldquo;ever breastfed\u0026rdquo; and continued breast feeding. The complementary indicators were introduction of solids, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, flesh food/egg consumption, sweet beverage consumption, unhealthy food consumption, and zero vegetable/fruit consumption. The independent variables included socio-demographic characteristics and maternal attendance of nutritional class. For the other study objectives, the variables were; source of nutrition information and added sugar consumption.\u003c/p\u003e\n\u003ch3\u003eData Management and Analysis\u003c/h3\u003e\n\u003cp\u003eDetails of data management have been published (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). Since this was a secondary analysis, only bivariate analysis was done for the complementary indicators; MDD and MAD. Nearly all achieved MMF and therefore no statistical test was performed for MMF. The outcomes MAD and MDD for each child were binary (\u0026ldquo;Yes\u0026rdquo; or \u0026ldquo;No\u0026rdquo;) having achieved the minimum requirements for the indicator or not. The statistical test used was modified Poisson.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eSocio-demographic characteristics of parents/caregivers and children aged 6\u0026ndash;23 months\u003c/h2\u003e\n \u003cp\u003eA total of 286 children aged 6\u0026ndash;23 months were included in the secondary analysis and these had equal proportions of males and females. 39.9% were infants (6\u0026ndash;12 months) while the rest were young children (aged 13\u0026ndash;23 months) with an overall median age of 14 months. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes their socio-demographic characteristics. Most of the caregivers were mothers (95.5%, n\u0026thinsp;=\u0026thinsp;273), among whom 86.8%, (n\u0026thinsp;=\u0026thinsp;237/273). Six (2%) of the caregivers were fathers while the seven were other relatives (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eAntenatal care attendance and nutrition education\u003c/h2\u003e\n \u003cp\u003eAmong the 273 mothers interviewed, 87% (n\u0026thinsp;=\u0026thinsp;237) reported having attended antenatal care (ANC) during pregnancy. Of those who attended ANC, 29.5% (n\u0026thinsp;=\u0026thinsp;70/237) had attended an infant nutrition class. Almost all that attended ANC (97.1%, n\u0026thinsp;=\u0026thinsp;67/69) had lessons on exclusive breastfeeding while only 29% (n\u0026thinsp;=\u0026thinsp;20/69) reported having information on the use of other foods like processed foods for IYC feeding. Other than health facilities, the commonest child nutrition information sources among the caregivers were: family (61.1%, n\u0026thinsp;=\u0026thinsp;165), friends (49.3%, n\u0026thinsp;=\u0026thinsp;134) and the internet (49.6%, n\u0026thinsp;=\u0026thinsp;133).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic characteristics of children and their parents among participants (N\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild\u0026rsquo;s sex (n\u0026thinsp;=\u0026thinsp;286)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild\u0026rsquo;s age in months (n\u0026thinsp;=\u0026thinsp;286)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e6\u0026ndash;12(infants)\u003c/p\u003e\n \u003cp\u003e13\u0026ndash;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship of caregiver\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003cp\u003eOther relative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e273\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e95.5\u003c/p\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParental characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents\u0026rsquo; marital status (n\u0026thinsp;=\u0026thinsp;281)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e90.0\u003c/p\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (n\u0026thinsp;=\u0026thinsp;278)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;25 years\u003c/p\u003e\n \u003cp\u003e26\u0026ndash;30 years\u003c/p\u003e\n \u003cp\u003e31\u0026ndash;35 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;36 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003cp\u003e29.9\u003c/p\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal education level (n\u0026thinsp;=\u0026thinsp;278)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNone/primary level\u003c/p\u003e\n \u003cp\u003eO\u0026rsquo; level completed\u003c/p\u003e\n \u003cp\u003eA\u0026rsquo; level/Tertiary\u003c/p\u003e\n \u003cp\u003eCollege/University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003cp\u003e59.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal occupation (n\u0026thinsp;=\u0026thinsp;249)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003cp\u003eSkilled, sales, services\u003c/p\u003e\n \u003cp\u003eProfessional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003cp\u003e54.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal education level (n\u0026thinsp;=\u0026thinsp;250)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eO\u0026rsquo; level or less completed\u003c/p\u003e\n \u003cp\u003eA\u0026rsquo; level/Tertiary\u003c/p\u003e\n \u003cp\u003eCollege/University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003cp\u003e71.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParental income (n\u0026thinsp;=\u0026thinsp;205)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIrregular\u003c/p\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 80.2723%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSES (n\u0026thinsp;=\u0026thinsp;275)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1st lowest\u003c/p\u003e\n \u003cp\u003e2nd middle\u003c/p\u003e\n \u003cp\u003e3rd highest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.1835%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003csub\u003e\u003cstrong\u003eSES was derived from a principal component analysis of home ownership, floor type, fuel type, toilet type, and land ownership with initial categorisation similar to those used to describe household characteristics by Uganda National Bureau of Statistics(UNBS) in demographic Health surveys (a. Uganda Bureau of Statistics (UBOS) \u0026amp; ICF., 2018).\u003c/strong\u003e\u0026nbsp;\u003c/sub\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMaternal health care and nutritional education-related characteristics for 6\u0026ndash;23 months children who attended selected health facilities in Kampala, (n\u0026thinsp;=\u0026thinsp;273*)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMother ever attended antenatal care (ANC) (n\u0026thinsp;=\u0026thinsp;273)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003cp\u003e86.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMother ever attended a nutritional class during ANC (n\u0026thinsp;=\u0026thinsp;237)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eEver had exclusive breastfeeding counsel (n\u0026thinsp;=\u0026thinsp;69)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSource of nutritional information(Yes)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFamily (n\u0026thinsp;=\u0026thinsp;270)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFriends (n\u0026thinsp;=\u0026thinsp;272)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial media (n\u0026thinsp;=\u0026thinsp;266)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMagazine (271)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTelevision (n\u0026thinsp;=\u0026thinsp;268)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eInternet (n\u0026thinsp;=\u0026thinsp;268)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e61.1\u003c/p\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e*Only 273 mothers were interviewed. The others were other caregivers\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eComplementary feeding practices and sugar use\u003c/h2\u003e\n \u003cp\u003eNearly all caregivers (97.6%, n\u0026thinsp;=\u0026thinsp;279/286) reported that the children had at least have ever breastfed since birth. However, at the time of the study, the proportion of children still breastfeeding had reduced to 68% (n\u0026thinsp;=\u0026thinsp;198). Among those aged 6\u0026ndash;8 months, 69% were feeding on semi-solid/solid food. Within the last 24 hours, 57.3% (n\u0026thinsp;=\u0026thinsp;164) consumed flesh or egg. Regarding unhealthy feeding practice indicators, 39.5% (n\u0026thinsp;=\u0026thinsp;113) did not eat any vegetables or fruit the day before, 38% and 37% had consumed sugar-sweetened beverages and unhealthy foods. When combined 71% had consumed at least one unhealthy food or beverage. In addition, 90% (n\u0026thinsp;=\u0026thinsp;257) of the children consumed sugar in either porridge or homemade juice (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Consumption of at least one traditional home-prepared meal within 24 hours was 92% (n\u0026thinsp;=\u0026thinsp;263), while the rest, 8% (n\u0026thinsp;=\u0026thinsp;23) consumed only unhealthy foods and beverages. Those that consumed at least one porridge meal 61%.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBreastfeeding, complementary indicators and added sugar consumption among 6-23-month old children that attended the selected health facilities in Kampala (n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Ever breastfed\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Continued breastfeeding (6\u0026ndash;23 months)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Solid/semi-solid foods (6\u0026ndash;8 months)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Egg and/or flesh\u0026copy; consumption (6\u0026ndash;23 months)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Zero vegetable or fresh fruit consumption (6\u0026ndash;23 months)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.5**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Sweet beverage consumption\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e^Unhealthy food consumption\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eTotal unhealthy food \u0026amp;beverage consumption\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eConsumption of added sugar\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e^ Calculated based on WHO infant and young child feeding indicators (WHO \u0026amp; UNICEF, 2021) * * * * \u0026ldquo;No\u0026rdquo; consumption **Percentage of no consumption\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026copy;Flesh foods include meat, fish, poultry, organic meats\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eMinimum infant and young child feeding practices\u003c/h2\u003e\n \u003cp\u003eOverall, just over a third (37.1%, n\u0026thinsp;=\u0026thinsp;106) met the minimum dietary diversity (MDD), nearly all (97.2%, n\u0026thinsp;=\u0026thinsp;278) met the minimum meal frequency (MMF), while about a third (33.9%, n\u0026thinsp;=\u0026thinsp;97) met the minimum acceptable diet (MAD). However, 30.4% (n\u0026thinsp;=\u0026thinsp;87) of the children consumed ultra-processed foods and did not meet the MAD. Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e summarises the percentage of children meeting the minimal complementary feeding indicators.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePercentage of children 6\u0026ndash;23 months of age meeting MDD, MMF and MAD indicators (n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndicator\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum dietary diversity, %\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u0026ndash;12 months (n\u0026thinsp;=\u0026thinsp;114)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e36 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u0026ndash;23 months (n\u0026thinsp;=\u0026thinsp;172)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e70 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum meal frequency %\u0026Dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e278 (97.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u0026ndash;8 months (n\u0026thinsp;=\u0026thinsp;48)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e45 (93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u0026ndash;23 months (n\u0026thinsp;=\u0026thinsp;238)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e233 (97.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum acceptable diet % \u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-breastfed (n\u0026thinsp;=\u0026thinsp;94)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e16 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreastfed (n\u0026thinsp;=\u0026thinsp;192)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e81 (42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eAll calculations were based on WHO infant and young child feeding indicators \u0026dagger;minimum dietary diversity was defined as consumption of at least five out of eight food categories by 6\u0026ndash;23 months old, including breastfeeding as a meal. \u0026Dagger; Calculated based on World Health Organisation infant and young child feeding indicators; minimum meal frequency was defined as at least two times for breastfed children 6\u0026ndash;8 months, at least three times for children 9\u0026ndash;23 months and at least four times for non-breastfed children 6\u0026ndash;23 month. \u003cspan\u003e$\u003c/span\u003eThe minimum acceptable diet is defined as \u0026bull;for breastfed children: receiving at least the minimum dietary diversity and minimum meal frequency for their age during the previous day; \u0026bull;for non-breastfed children: receiving at least the minimum dietary diversity and minimum meal frequency for their age during the previous day as well as at least two milk feeds (WHO \u0026amp; UNICEF, 2021).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBivariate analysis of the association between complementary feeding indicators (MDD and MAD) and socio-demographic characteristics among 6-23-month old children in Kampala (n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable overall\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMDD\u003c/p\u003e\n \u003cp\u003ePR, 95% CI, \u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMAD\u003c/p\u003e\n \u003cp\u003ePR, 95% CI, \u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eChild sex\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.32, 0.97\u0026ndash;1.80, 0.074\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.44, 1.04\u0026ndash;2.01, 0.030*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChild\u0026rsquo;s age in months (n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\n \u003cp\u003e6\u0026ndash;12(infants)\u003c/p\u003e\n \u003cp\u003e13\u0026ndash;23\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.29, 0.93\u0026ndash;1.78, 0.127\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.23, 0,87-1.73, 0.242\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal education level (n\u0026thinsp;=\u0026thinsp;278)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo education/primary level completed\u003c/p\u003e\n \u003cp\u003eO levels completed\u003c/p\u003e\n \u003cp\u003eA level/Technical/Vocational completed\u003c/p\u003e\n \u003cp\u003eCollege/University completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e2.99, 0.93\u0026ndash;9.59, 0.065\u003c/p\u003e\n \u003cp\u003e3.60, 1.48\u0026ndash;11.26, 0.028*\u003c/p\u003e\n \u003cp\u003e4.24, 1.43\u0026ndash;12.28, 0.009*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e0.92, 0.83-1.0, 0.076\u003c/p\u003e\n \u003cp\u003e0.88, 0.80\u0026ndash;0.98, 0.017*\u003c/p\u003e\n \u003cp\u003e0.84, 0.78\u0026ndash;0.90,\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (n\u0026thinsp;=\u0026thinsp;278)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;25 years\u003c/p\u003e\n \u003cp\u003e26\u0026ndash;30 years\u003c/p\u003e\n \u003cp\u003e31\u0026ndash;35 years\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;36 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.80, 1.05\u0026ndash;3.08, 0.032*\u003c/p\u003e\n \u003cp\u003e1.20, 0.66\u0026ndash;2.17, 0.536\u003c/p\u003e\n \u003cp\u003e1.87, 1.05\u0026ndash;3.34, 0.033*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e0.90, 0.83\u0026ndash;1.01, 0.076\u003c/p\u003e\n \u003cp\u003e0.97, 0.88\u0026ndash;1.06, 0.444\u003c/p\u003e\n \u003cp\u003e0.89, 0.79\u0026ndash;0.99, 0.040*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic status (n\u0026thinsp;=\u0026thinsp;275)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1st (lowest)\u003c/p\u003e\n \u003cp\u003e2nd (middle)\u003c/p\u003e\n \u003cp\u003e3rd (highest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.72,1.14\u0026ndash;2.59,0.009*\u003c/p\u003e\n \u003cp\u003e1.63,1.06\u0026ndash;2.51,0.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e0.89, 0.82\u0026ndash;0.96, 0.003*\u003c/p\u003e\n \u003cp\u003e0.91, 0.84\u0026ndash;0.99, 0.022*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother attended nutritional class (n\u0026thinsp;=\u0026thinsp;237\u003c/strong\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e0.92, 0.63\u0026ndash;1.32, 0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003cp\u003e1.03, 0.96\u0026ndash;1.12, 0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eRef is the baseline comparative group whose adjusted PR is \u0026ldquo;1\u0026rdquo;. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003cp\u003eThe data in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e shows that children from families with middle and high socio-economic scores (SES) were more likely to meet MDD and therefore also meet the MAD requirements than those from low SES. Maternal education was positively associated with achieving both MDD and MAD, with the highest two levels significant for MDD. Females were 1.4 times more likely to meet MAD than makes.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBreastfeeding practices and sugar use\u003c/h2\u003e \u003cp\u003eThe present study sought to establish key complementary feeding practices as defined by WHO and the sugar consumption of an urban population. Nearly all mothers in the present study reported ever breastfeeding their children similar to the national reports (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and other countries like Tanzania where 99.7% of 0-23-month children had ever breastfed. However, these proportions are generally higher than in other SSA countries (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). As expected, the percentage of breastfeeding children dropped as they grew older. At the time of the study, more than two thirds were still breastfeeding, a higher proportion than the SSA average (54%) from 32 countries (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and the Uganda national rate (43.2%) among 6\u0026ndash;23 months old (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHigher breastfeeding rates suggest the urban population is more responsive to educational messages due to aggressive breastfeeding campaigns supported by the Ugandan IYCF policy (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Longer breastfeeding duration might also result from greater exposure to family planning messages and access to contraceptives, increasing the interval between births (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), compared to the rest of the national population (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Despite higher breastfeeding rates, efforts are needed to strengthen policies supporting exclusive breastfeeding for the first six months and continued breastfeeding for at least two years, as recommended by WHO (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is concerning that 90% of the children consumed sugar or honey in their drinks, including cereal porridge, tea, and homemade juice. This habit is common in the Ugandan urban setting and other African and Asian urban populations (Nepal, Indonesia, Tanzania, and Senegal), where consumption levels ranged from 23\u0026ndash;80% among 6\u0026ndash;23 months old. However, the African cities; Dar-es-Salaam and Dakar had higher sugar consumption than Asian cities (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), suggesting that adding sugar to children's drinks might be a more common feeding practice in Africa.\u003c/p\u003e \u003cp\u003e Adding sweeteners to drinks at home should be discouraged, and guidelines on appropriate amounts should be provided. Studies have shown that there is no nutritional requirement for free or added sugars, as demonstrated in children with fructose intolerance who had favourable health outcomes when sugar intakes were eliminated (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Instead, free sugars provide significant energy without specific nutrients (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Due to such concerns, the WHO provided evidenced guidelines for free sugar consumption to be limited to 10% of the total energy intake to prevent (NR-NCDs) and preferably a further reduction to less than 5% for dental health (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince children from all age groups consumed added sugar, it highlights the minimal nutritional education on sugar in IYC feeding in this urban population. Findings from Burkina Faso indicated that increasing the sweetness of porridge led to increased consumption (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Consuming high quantities of gruels at the expense of nutrient-rich foods compromises nutrient intake, as gruels are energy-dense but nutrient-poor (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This reveals risks for poor dental health and early preference for sweet tastes. Additionally, honey is not recommended for infants due to the risk of \u003cem\u003eClostridium botulinum\u003c/em\u003e toxins, which can cause botulism (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMinimal complementary feeding indicators\u003c/h2\u003e \u003cp\u003eThe percentage of 6-8-month-old infants who fed on semi-solid/solid foods (69%) was similar to the SSA average (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) but lower than the national estimate (81%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and other SSA countries like Tanzania, Congo Republic, and Mozambique (\u0026gt;\u0026thinsp;90%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These findings indicate many urban children experience suboptimal diets at an age when their bodies need the most energy from foods other than breast milk, which becomes insufficient by six months (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings indicate that 37% of children met the MDD, comparable to the national (30%) and Kampala (39%) estimates. The MMF was more than twice the national estimates (41%) estimates and higher than the Kampala estimates (67%). This could due to this study\u0026rsquo;s definition of MMF based on the latest guidelines (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The MMF definition in the 2016 UDHS (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) has changed from considering four milk feeds for non-breastfed children to including at least one semi-solid non-milk feeding (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) which can significantly boost the current MMF score. Given that most children took porridge and overall eight tenths ate at least one local meal, meeting the MMF is achievable for this urban population. Furthermore, (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)a high MMF could also be due to the higher wealth percentile of participants compared to UDHS (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The urban population scored positively on homeownership, floor type, fuel type, toilet type, and land ownership, indicators of wealth and socio-economic status. Higher wealth percentile scores predict IYC nutrition indicators in Uganda (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite a high MMF, the low MDD indicates that the majority of the 6-23-month-old children's diets were micronutrient-poor and of poor quality. The high consumption of unhealthy foods and sweet beverages could explain this. For example, \u0026ldquo;milk feeds\u0026rdquo; composed of sweetened yogurts and sweetened milk, although fulfilling MMF and MDD criteria, are ultra-processed and thus questionable for IYC.\u003c/p\u003e \u003cp\u003eTherefore, when the Ugandan IYC guidelines are being updated, it is vital to acknowledge the heterogeneity of populations in feeding patterns across different regions (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)., including those with access to and who can afford commercial ultra-processed foods/beverages. For such scenarios, emphasis should be put on aspects that cover the quality of these products while being contextually specific and relevant to these population differences (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe national (15%) and Kampala (16%) MAD estimates were half the MAD in this study (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The significantly high MMF might explain the MAD variance between surveys which UDHS might not emphasise using the older guidelines. UDHS likely focuses on traditional home-prepared foods, important in rural areas, while urban settings include substantial commercial food consumption some of which are ultra-processed. Therefore, in future surveys, UDHS should include the new indicators for unhealthy foods and beverages (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and especially for urban areas experiencing nutrition transitions.\u003c/p\u003e \u003cp\u003eComparisons of the three indicators between this study and the last UDHS are not ideal, especially for minimum complementary indicators, as previous studies used different WHO definitions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The recent WHO updates emphasise breastfeeding in the MDD and changes to the MMF definition which in turn affect the MAD indicator in the latest definitions (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe subgroups of big concern include those that did not consume home-prepared foods or semi-solids/solids who risk malnutrition by replacing micronutrient-rich local foods with nutrient-poor unhealthy foods and beverages (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). For example several failed to meet the MAD including non-consumption of meat or eggs, vegetables or fruits. This reflects early-life nutrition transition in urban populations, with lower vegetable and fruit consumption replaced by sugary beverages (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe three indicators\u0026mdash;MDD, MMF, and MAD\u0026mdash;are effective proxies for assessing feeding practices, including ultra-processed food and beverage consumption (UPFB), as shown in this study. Including UPFB provides additional information on the vulnerability of subpopulations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Therefore, future studies in LMIC should include measures on unhealthy UPFB consumption to evaluate IYC feeding practices comprehensively. Unfortunately, there are few published SSA studies on this topic, covering only two urban African populations (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), making comparisons challenging.\u003c/p\u003e \u003cp\u003eWhen examining socio-demographic factors, maternal education and higher socio-economic status were positively associated with MDD and MAD, as seen in UDHS findings (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and this has been also been linked to healthier dietary patterns (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Maternal education aids in acquiring IYCF knowledge, while higher socio-economic status allows access to diverse, healthy foods (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). LMIC studies suggest these factors empower women, aiding in child feeding decisions (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnexpectedly, attending a nutritional class was not significantly associated with MDD or MAD. Nutritional counselling, effective in improving malnourished children's nutritional status (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), might require repeated exposure to consistent IYCF messages. One-off or unstructured interactions at health facilities may not be as effective. A Kenyan study found that mothers exposed to IYCF messages 3\u0026ndash;4 times had better knowledge (p\u0026thinsp;=\u0026thinsp;0.01) and attitude scores (p\u0026thinsp;=\u0026thinsp;0.08) than those exposed only once (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) suggesting the need for structured nutritional education with repeated exposure (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSource of nutritional information\u003c/h2\u003e \u003cp\u003eThe survey for mothers included questions about their access to and sources of nutritional information. \u0026ldquo;Family\u0026rdquo; was the most common source, while nearly half sought information from the internet and friends. Surprisingly, fewer mothers accessed nutritional information from health facilities during ante-natal care. These findings suggest that nutritional education should adopt a population-wide approach, reaching as many people and cultures as possible. Messages should be updated to include information on UPFB and tailored to local evidence from different regions.\u003c/p\u003e \u003cp\u003eGiven many mothers have internet access, this should be leveraged with contextual messages on IYCF and maternal nutrition. The latest framework on maternal, infant, young child, and adolescent nutrition (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) does not recognise this strategy. However, for literate, educated populations with internet access, this could be a cost-effective way of delivering messages across different age groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights significant insights into complementary feeding practices, sugar consumption, and sources of nutrition information among caregivers in urban Kampala, Uganda. High breastfeeding rates were noted, but there was significant sugar consumption and low dietary diversity among children. Higher maternal education and socio-economic status correlated with better dietary outcomes.\u003c/p\u003e \u003cp\u003eBreastfeeding practices in this population were acceptable (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), but complementary practices were deficient. Policies should shift focus from only exclusive breastfeeding and timing of introducing complementary foods to the quality of both processed and home-prepared foods. Current guidelines inadequately address processed foods, assuming the population relies solely on traditional homemade foods.\u003c/p\u003e \u003cp\u003eMany children consumed unhealthy foods and beverages and yet did not meet MDD. Ultra-processed foods like sweetened flavoured yoghurt, lack nutritive value and should not count towards MDD, but current guidelines do not address this (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Guidelines should specify excluding nutritionally poor foods from MMF and MDD indicators, while providing contextually appropriate descriptions. Furthermore, the widespread use of sugar emphasises the need for targeted policies to improve the nutritional quality of children\u0026rsquo;s diets. Nutritional education should utilise the internet and other key sources of information to disseminate evidence-based IYCF practices.\u003c/p\u003e \u003cp\u003eFuture research should include longitudinal methods and comprehensive assessments of nutritional and health indicators, such as stunting, wasting, overweight, and dental caries. Additionally, understanding the socio-economic and cultural factors influencing feeding practices is crucial for effective interventions. Improving complementary feeding practices in urban Kampala can enhance children\u0026rsquo;s nutritional outcomes and overall health, underscoring the need for continuous monitoring and targeted, inclusive policies.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations that must be considered when interpreting the findings. Firstly, this was a secondary analysis and as a result, we were unable to perform a multivariate analysis to examine the associations between different socio-demographic factors and the IYCF indicators because of limited power calculations. This limitation restricts our ability to control for potential confounding variables and to fully explore the complex relationships between these factors and the feeding practices observed.\u003c/p\u003e \u003cp\u003eThe data on feeding practices and dietary intake were self-reported by caregivers, which may introduce recall bias and social desirability bias. Caregivers might over report or underreport certain behaviours, such as breastfeeding duration or the frequency of sugar consumption, to align with perceived desirable practices. Additionally, while the 24-hour dietary recall method provides valuable insights into recent feeding practices, it may not accurately reflect usual dietary intake over time. A single day\u0026rsquo;s intake may not capture variations in the child's diet, and more comprehensive dietary assessment methods would provide a fuller picture of nutritional adequacy. Additionally, key nutritional status indicators such as stunting, wasting, overweight and obesity, and dental caries were not collected, which would have given a more comprehensive assessment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;ANC - Antenatal Care\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;ECC - Early Childhood Caries\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;IYCF - Infant and Young Child Feeding\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;LMICs - Low- and Middle-Income Countries\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;MAD - Minimum Acceptable Diet\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;MDD - Minimum Dietary Diversity\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;NR-NCDs - Nutrition-Related Non-Communicable Diseases\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;SES - Socioeconomic Status\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;UBOS - Uganda Bureau of Statistics\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp; \u0026nbsp;UPFB - Ultra-Processed Foods and Beverages\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026nbsp; WHO - World Health Organisation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The parent study protocol received ethical approvals from the Makerere University's School of Health Sciences Higher Degrees (Ethics Reference No. MAKSHSREC-2021-138) and Research Ethics Committee, and the Uganda National Council of Science and Technology (Research registration No. HS1784ES). All participants provided written consent before data collection, with participation being voluntary and the option to withdraw at any stage. Permission was also obtained from health facility administrations to conduct the research on their premises. The survey was conducted anonymously to ensure privacy and confidentiality. When caregivers were not relatives, consent was obtained from both parents and the caregiver.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe work was supported by the Fogarty International Center of the National Institutes of Health, U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC) and President's Emergency Plan for AIDS Relief (PEPFAR) under Award Number 1R25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eC.L.M and S.N conceived and refined the research idea, drafted the initial proposal, and were involved in the whole research process till drafting of the manuscript. The co-authors B.N, D.K, M.G.N and A.M.K contributed to the drafting of the manuscript. G.S.N was involved in developing the research tool, collecting the primary data, analysing the data, and reviewed the drafted manuscript. All co-authors gave the final approval of the version to be published.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe following people are acknowledged for their tremendous contribution towards the study: Ms Prisca Kusasira, Ms Madina Nadduli during the extensive primary data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data sets supporting the conclusions of this article are available and can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO, UNICEF. Indicators for assessing infant and young child feeding practices part 1: definitions. In. Geneva: WHO; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO, UNICEF. Indicators for assessing infant and young child feeding practices: definitions and measurement methods. In. 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Public Health Nutr. 2021;24(12):3845\u0026ndash;58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1368980021002342\u003c/span\u003e\u003cspan address=\"10.1017/S1368980021002342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Infant and young child feeding, Complementary feeding, Sugar consumption, Urban nutrition transition, Dietary diversity, Nutritional education, Ultra-processed foods, Kampala, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-5380882/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5380882/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe World Health Organization has established key indicators to monitor infant and young child feeding practices globally, particularly in low- and middle-income countries. In urban areas, the nutrition transition from traditional diets has increased the consumption of ultra-processed foods/beverages and added sugar, raising concerns about their impact on children's diets and health. This study aimed to investigate complementary feeding practices, added sugar use, and sources of nutrition information among caregivers of young children in Kampala, Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis secondary analysis was conducted in August 2024, using data from a cross-sectional study conducted in 2021 on commercial baby food consumption among 6\u0026ndash;36 month olds in Kampala, Uganda. For this analysis, 286 children aged 6\u0026ndash;23 months were selected through systematic sampling. Data collection focused on eight WHO complementary and two breastfeeding indicators, sources of nutrition information, and added sugar consumption. Descriptive statistics and modified Poisson regression assessed associations to examine the association between socio-demographic factors and dietary indicators.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 286 children aged 6\u0026ndash;23 months with a median age of 14 months. Nearly all caregivers reported that the children had ever breastfed since the birth, with 67.1% still breastfeeding at the time of the study. Added sugar consumption was high, with 89.9% of children consuming added sugars. Only 37.1% met the minimum dietary diversity, and 33.9% met the minimum acceptable diet. Higher maternal education and socio-economic status were associated with better dietary diversity and acceptable diet. Family and the internet were the most common sources of nutrition information.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eComplementary feeding practices in urban Kampala reveal high breastfeeding rates but significant added sugar consumption and low dietary diversity. There is a need for policies and guidelines emphasising the quality of both commercial and home-prepared foods and addressing the consumption of ultra-processed foods and beverages. Nutritional education should leverage internet access to deliver tailored infant and young child feeding messages effectively. Improving complementary feeding practices can enhance children's nutritional outcomes and overall health in urban Uganda. This study underscores the importance of targeted interventions and policy measures to promote optimal feeding practices and improve the nutritional status of young children.\u003c/p\u003e","manuscriptTitle":"Complementary feeding practices and added sugar consumption among urban children aged 6-23 months in Kampala, Uganda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-05 04:18:36","doi":"10.21203/rs.3.rs-5380882/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c8ac4412-e18b-485d-819d-10313c0bcd5a","owner":[],"postedDate":"November 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-14T08:09:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-05 04:18:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5380882","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5380882","identity":"rs-5380882","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}