Determinants of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda: a cross-sectional study

Determinants of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, Kanungu District, 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 Determinants of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda: a cross-sectional study Gaston Ampe, Chrispus Tumwebaze, Edward Kansiime This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9168381/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background Children aged 6–23 months are particularly vulnerable to undernutrition, as breast milk alone can no longer meet their nutritional needs, and as such, the quality and quantity of the complementary foods they eat become critical. To assess whether a child in this age group is being fed adequately, researchers and health programmes use a composite indicator called minimum acceptable diet (MAD), which includes two variables: how often a child is fed (minimum meal frequency, MMF) and how diverse their diet is (minimum dietary diversity, MDD). Methods We conducted a community-based cross-sectional analytical study among caregivers of children aged 6–23 months living in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda. Data were collected using an interviewer-administered questionnaire capturing socio-demographic characteristics, infant and young child feeding (IYCF) knowledge, household food security, and a 24-hour dietary recall. MAD was defined based on whether the child met both MDD and MMF. Household food security was measured using the Household Food Insecurity Access Scale (HFIAS). Nutrition knowledge was assessed with a 13-item scale and categorized as sufficient (≥ 7) or insufficient (0–6). We used chi-square tests and crude odds ratios (COR) for bivariate analysis, and multiple logistic regression to identify independent determinants of MAD, with statistical significance set at 5%. Results Of 196 targeted participants, 147 caregivers were interviewed, and 126 questionnaires were valid for analysis. Overall, 89.7% of children met MMF, 21.4% met MDD, and 18.3% met MAD. In multivariable analysis, key determinants of meeting MAD were birth order (being third-born or later), higher weekly earnings, household food security, and sufficient caregiver nutrition knowledge. Conclusions The proportion of children aged 6–23 months who met MAD in Eastern Ward was low, largely driven by poor dietary diversity despite most children receiving meals frequently enough. Interventions to improve complementary feeding should combine community-based nutrition education and social behaviour change approaches with efforts to enhance household food security and access to affordable, diverse foods. minimum acceptable diet minimum dietary diversity minimum meal frequency complementary feeding infant and young child feeding Background Minimum dietary diversity (MDD) for children 6–23 months is defined as consuming foods from at least five of eight food groups in the previous 24 hours and is an indicator for micronutrient adequacy [ 1 ]. Minimum meal frequency (MMF) refers to receiving, in the previous 24 hours, at least two feeds for breastfed infants 6–8 months, at least three feeds for breastfed children 9–23 months, and at least four feeds for non-breastfed children 6–23 months being an indicator for energy adequacy [ 2 ]. A child meets the minimum acceptable diet (MAD) if both MDD and MMF are achieved. Adequate complementary feeding during this period supports linear growth, cognitive development, school performance, immune function and later-life productivity [ 3 ]. In contrast, not meeting MAD contributes to undernutrition with long-term consequences, including heightened risk of metabolic disease and reduced work capacity in adulthood [ 4 , 5 ]. Children aged 6–23 months are particularly vulnerable because they are shifting from exclusive breastfeeding to family foods, and breast milk alone no longer provides all required nutrients [ 6 ]. Barriers to optimal infant and young child feeding (IYCF) are multifaceted and include caregiver knowledge and cultural norms [ 7 ], household poverty [ 8 ], caregiver education and income, access to productive assets such as gardens and livestock [ 9 ], household size, and the ages of both caregiver and child [ 10 ]. Improving dietary diversity in particular often depends on a more diverse local food system, social support, and women’s empowerment [ 11 ]. Globally, malnutrition remains a major driver of under-five morbidity and mortality [ 12 , 13 ]. In Uganda, undernutrition remains a significant public health challenge; national surveys have documented substantial levels of stunting and underweight among children under five [ 14 ]. The Ministry of Health has also highlighted that complementary feeding remains suboptimal, with a very low still declining proportion of children consuming diets that meet MDD (18%) and MAD (14%) in 2016 reducing further to 10% (MDD) and 7% (MAD) in 2022 [ 15 ]. While secondary analyses of national survey data have identified predictors of MDD and MMF at the national level [ 16 ], less is known about the determinants of MAD in specific local settings, where context-specific drivers may differ. This study therefore aimed to assess the determinants of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda. Methods and materials Study setting and design The study took place in Eastern Ward of Buhoma Town Council in Kanungu District, south-western Uganda. Eastern Ward comprises the villages of Nyakeina, Rubona, Kyumbugushu, Iraro, Kashebeya and Kakarati. The area is hilly, with much of the population living on hill plateaus. Most residents rely on agriculture, including tea cultivation and subsistence farming, with additional income opportunities linked to tourism around Bwindi Impenetrable National Park. We used a community-based cross-sectional analytical design, enrolling caregivers of children aged 6–23 months who resided in Eastern Ward. A household member was defined as someone who had stayed in the household for at least 30 days prior to the study. In households where more than one eligible child was present, one was selected using simple random sampling. Sampling and sample size Systematic sampling was used. A sampling frame of eligible children was compiled, a random start was chosen, and then every nth child was selected according to the sampling interval. The required sample size was estimated using the Cochran formula as adapted from Singh and Masuku [ 17 ]: N = Z²PQ / e² where Z is the critical value corresponding to a 95% confidence level, P is the estimated prevalence (85% in the original calculation), Q = 1 − P, and e is the desired precision (5%). This yielded a target sample size of 196. Data collection Data were collected using an interviewer-administered structured questionnaire together with a 24-hour dietary recall. The data collection tool had been specifically designed for this study. The tools were translated from English into a local language called Runyankore–Rukiga to improve comprehension. Outcome variable: minimum acceptable diet (MAD) MAD was determined from the 24-hour recall of all foods and beverages consumed by the child. MDD and MMF were first computed and then combined. For MDD, foods were grouped into eight categories:1 breast milk; 2 grains, roots and tubers; 3 legumes and nuts; 4 dairy products; 5 flesh foods; 6 eggs; 7 vitamin A-rich fruits and vegetables; and 8; other fruits and vegetables. A child met MDD if they consumed foods from at least five of these eight groups. For MMF, we counted the eating occasions of solid, semi-solid or soft foods in the previous 24 hours and compared it with age- and breastfeeding-status-specific thresholds: at least two times for breastfed children 6–8 months; at least three times for breastfed children 9–23 months; and at least four times for non-breastfed children 6–23 months. A child was classified as having met MAD if they met both MDD and MMF; otherwise they were classified as not meeting MAD. Explanatory variables Child-level variables included age, sex, birth order, whether breastfeeding was initiated within 1 hour of birth, receipt of prelacteal feeds, and current breastfeeding status. Caregiver-level variables included age, marital status, weekly earnings, highest education level, work status, and whether they had ever received IYCF counselling. Household-level variables included food security status, household size, and family type. Nutrition knowledge Caregiver IYCF knowledge was assessed with a 13-item scale adapted from FAO KAP guidance [ 18 ]. Each correct response scored 1 point and each incorrect response 0, for a maximum of 13. Scores were categorized as sufficient (≥ 7) or insufficient (0–6). Household food security Household food security was assessed using the Household Food Insecurity Access Scale (HFIAS) [ 19 ]. As applied in this study, households that responded “yes” to any of questions 2–9 were categorized as food insecure. Data management and analysis Of the 196 targeted participants, 147 caregivers were interviewed. Eleven questionnaires were invalid, leaving 126 for analysis. Data were coded and entered, and analysis was conducted using SPSS version 20. Descriptive statistics were used to summarize child, caregiver and household characteristics. Bivariate analyses using chi-square tests assessed associations between independent variables and MAD, and crude odds ratios (COR) were calculated. Variables with p < 0.05 or those considered conceptually important were entered into a multiple logistic regression model. Backward stepwise elimination was used to identify independent determinants of MAD. Model fit was assessed with the Hosmer-Lemeshow goodness-of-fit test. In the final model, variables with p < 0.05 were retained, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. Results Participant characteristics Among the 126 children included in the analysis, 39.7% were aged 6–8 months and 60.3% were aged 9–23 months. Slightly more than half (54.8%) were female. Most children (61.9%) were first-born. Breastfeeding was initiated within the first hour after birth for 69.0% of children. Prelacteal feeds were not given to 75.4%. At the time of the survey, 62.7% of children were still breastfeeding. Most caregivers were 20–35 years old (54.0%) and married (70.6%). Weekly earnings were less than USD 8 for 52.4% of caregivers. A small proportion had tertiary education or higher (9.5%). About half (50.8%) were engaged in work. Regarding households, 45.2% were food insecure, and just over half (56.3%) had 3–5 members as shown in Table 1 . Table 1 Demographic characteristics of respondents (n = 126) Characteristics Frequency Percentage Child characteristics Age 6–8 months 50 39.7 Age 9–23 months 76 60.3 Male 57 45.2 Female 69 54.8 Birth order: first 78 61.9 Birth order: second 29 23.0 Birth order: third and above 19 15.1 Breast initiation within 1 hour: yes 87 69.0 Breast initiation within 1 hour: no 39 31.0 Prelacteals: yes 31 24.6 Prelacteals: no 95 75.4 Breastfeeding: yes 79 62.7 Breastfeeding: no 47 37.3 Caregiver characteristics Age < 20 years 28 22.2 Age 20–35 years 68 54.0 Age 36–50 years 30 23.8 Married 89 70.6 Single 32 25.4 Divorced 5 4.0 Weekly earnings $ 55 10 7.9 Education: never gone to school 41 32.5 Education: primary 55 43.7 Education: secondary 18 14.3 Education: tertiary and above 12 9.5 Working 64 50.8 Not working 62 49.2 Household characteristics Food security status: yes 69 54.8 Food security status: no 57 45.2 HH size 1–2 25 19.8 HH size 3–5 71 56.3 HH size > 5 30 23.8 Caregiver knowledge toward IYCF practices Most caregivers knew that breastfeeding should continue until 2 years of age (75.4%), that the first food for a newborn should be breast milk only (72.2%), and that breastfeeding should be initiated within 1 hour after birth (67.5%). Knowledge was weaker for topics related to anaemia: only 17.5% correctly identified causes of anaemia and 24.6% recognized signs of iron-deficiency anaemia. Overall, 65.9% of caregivers had insufficient IYCF knowledge based on the 13-item score as shown in Table 2 . Table 2 Proportion of caregivers answering “Yes” to knowledge statements (n = 126) Statement Frequency Percent First food for a newborn is breast milk only 91 72.2 Breastfeeding should be initiated within 1 hour after birth 85 67.5 Child < 6 months should be breastfed on demand 57 45.2 Expressed breast milk should be fed to child in mother’s absence 41 32.5 Cessation of breastfeeding is at 2 years 95 75.4 Child should be breastfed on-demand after weaning 42 33.3 A child could be weaned at 6 months 40 31.7 Child 6–8 months should be fed at least twice a day 49 38.9 Child 9–23 months should be fed three or more times a day 73 57.9 There are 8 food groups a child’s meal should be planned with 31 24.6 Aware of signs of iron-deficiency anaemia 31 24.6 Aware of causes of anaemia 22 17.5 Sufficient knowledge (≥ 7) 43 34.1 Proportion meeting MMF, MDD and MAD Overall, 89.7% of children met MMF, indicating that most were being fed often enough according to age and breastfeeding status. However, only 21.4% met MDD, and consequently just 18.3% met MAD. Subgroup figures and one of the original graphs were internally inconsistent with the reported overall totals; therefore, only the clearly stated overall prevalence values are presented here. Factors associated with meeting MAD (bivariate analysis) Meeting MAD was significantly associated with birth order (third and above), weekly earnings, education level, household food security status, and caregiver nutrition knowledge (p < 0.05) as indicated in Table 3 . No significant associations were found for child age, sex, breastfeeding initiation, prelacteal feeding, breastfeeding status, maternal age, marital status, work status, IYCF counselling, household size or family status (p > 0.05). Table 3 Factors associated with MAD from bivariate model (n = 126) Variable COR 95% CI p-value Child age (6–8 months) 0.473 0.172–1.298 0.14 Sex (male) 1.406 0.568–3.479 0.46 Birth order (third and above) 2.23 1.43–3.22 0.00 Breast initiation (yes) 1.336 0.482–3.699 0.577 Prelacteal use (no) 0.823 0.278–2.437 0.724 Breastfeeding status (yes) 0.909 0.359–2.301 0.841 Maternal age (< 18 years) 0.06 0.034–1.96 0.88 Marital status (married) 1.31 0.82–2.43 0.815 Weekly earnings ( $ 28– $ 55) 1.53 1.33–4.21 0.00 Education level (tertiary) 1.137 0.897–1.43 0.00 Work status (working) 1.325 0.533–3.294 0.543 IYCF counselling (yes) 0.711 0.287–1.76 0.46 Food security (food secure) 8.289 3.074–22.355 0.00 HH size (1–2 members) 0.876 0.64–1.23 0.056 Family status (nuclear) 1.34 0.76–1.33 0.118 Nutrition knowledge (sufficient) 3.163 1.251–7.998 0.012 Determinants of meeting MAD (multivariable analysis) In the final logistic regression model, determinants of meeting MAD included birth order, weekly earnings, household food security status, and caregiver nutrition knowledge as shown in Table 4 . Table 4 Multiple logistic regression for determinants of MAD (n = 126) (Presented as in the source document; confidence interval lower bounds recorded as 0.000 in the source appear to reflect rounding/output issues and should be replaced with exact SPSS output values during final journal preparation.) Characteristic p-value AOR 95% CI (Lower–Upper) Child age: 6–8 months (ref: 9–23 months) 0.09 1.885 0.006–2.391 Birth order: second (ref: first) 0.045 1.602 0.034–0.65 Birth order: third and above (ref: first) 0.033 4.732 1.32–6.632 Weekly earnings: $ 8– $ 28 (ref: > $ 55) 0.009 0.063 0.000–0.763 Weekly earnings: $ 28– $ 55 (ref: > $ 55) 0.009 0.047 0.000–0.82 Weekly earnings: $ 55) 0.008 0.020 0.000–0.98 Education: secondary (ref: tertiary and above) 0.098 0.667 0.000–23.98 Education: primary (ref: tertiary and above) 0.098 0.397 0.000–17.85 Education: never gone to school (ref: tertiary and above) 0.098 0.12 0.000–13.37 Work status: working (ref: not working) 0.33 3.054 0.22–9.842 IYCF counselling: yes (ref: no) 0.063 1.043 0.056–3.156 Food security: food insecure (ref: food secure) 0.036 2.21 1.6–2.9 HH size: 1–2 (ref: >5) 0.375 7.645 0.085–12.069 HH size: 3–5 (ref: >5) 0.440 3.33 0.021–5.412 Family status: single mother/father (ref: extended) 0.523 0.276 0.005–1.296 Family status: nuclear (ref: extended) 0.617 1.840 0.169–2.085 Nutrition knowledge: sufficient (ref: insufficient) 0.02 3.03 1.67–6.1 Birth order Children who were third-born or later had higher odds of meeting MAD compared with first-born children. This may reflect greater caregiver experience with infant feeding and possible modelling or influence from older siblings. Weekly earnings Compared to caregivers with the highest weekly earnings (> USD 55), those in lower earning categories had substantially reduced odds of meeting MAD, indicating that economic constraints likely limit the ability to purchase and provide a diverse range of complementary foods. Household food security Children in food-secure households were more likely to meet MAD than those in food-insecure households, consistent with the idea that reliable access to sufficient food enhances both meal frequency and dietary diversity. Caregiver nutrition knowledge Children whose caregivers had sufficient IYCF knowledge had higher odds of meeting MAD than those whose caregivers had insufficient knowledge. Better knowledge may support more appropriate choices regarding both the variety and frequency of foods offered. Some variables, such as education level, showed significance in bivariate analysis but became non-significant in the multivariable model. This may be due to overlap between education, income, and other contextual factors, or limited variation in occupations and income sources in the study setting. Discussion This study assessed prevalence and determinants of MAD among children 6–23 months in Eastern Ward, Buhoma Town Council. The study found that fewer than one in five children aged 6–23 months, met the minimum acceptable diet, even though almost nine in ten met the minimum meal frequency which reflects national studies as already reported [ 15 ]. The main limiting factor was dietary diversity, echoing national and regional findings that children often eat frequently but from a narrow range of foods. The association between higher birth order and increased likelihood of meeting MAD suggests that caregivers may become more confident and skilled in feeding with subsequent children, or that older siblings influence the younger child’s exposure to a wider variety of foods [ 20 , 21 ]. However, this pattern could also be shaped by other household dynamics and warrants further exploration. Lower weekly earnings were strongly associated with lower odds of meeting MAD, consistent with studies from other low- and middle-income settings showing that income and overall socioeconomic status are key determinants of dietary diversity and diet quality [ 22 – 24 ]. When financial resources are limited, caregivers may prioritize staple foods and forego more diverse, often more expensive, animal-source foods, fruits and vegetables. Household food security emerged as another important determinant. Food-insecure households may experience seasonal shortages, rely heavily on a limited set of staples, and have fewer options for achieving dietary diversity. These constraints can affect both meal frequency and diversity, but in this setting appear to have had a particularly marked impact on diversity [ 19 ]. Caregiver nutrition knowledge was also a significant determinant of MAD. Caregivers who understood the recommended feeding frequency and the need to include multiple food groups, and who were aware of the consequences of micronutrient deficiencies, were more likely to meet MAD with their children. This underscores the value of well-designed IYCF counselling and practical, context-specific nutrition education delivered through health facilities, community health workers and other community platforms. Education level was associated with MAD in bivariate analysis but not in the adjusted model. One possible explanation is that, within this community, opportunities for income generation and access to food may not differ greatly by education level, particularly where agriculture, tea growing and tourism dominate livelihoods. Conclusions The prevalence of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, was low. Despite most children being fed often enough, their diets lacked sufficient diversity. Key determinants of meeting MAD included higher birth order, greater weekly earnings, household food security and sufficient caregiver nutrition knowledge. Efforts to improve complementary feeding in this setting should go beyond general messaging to focus on practical ways families can diversify children’s diets using locally available foods, while maintaining appropriate feeding frequency. Programs should prioritize poorer and food-insecure households and provide targeted support for first-time mothers and caregivers. Strengthening community nutrition education and social behaviour change communication, alongside broader interventions aimed at improving household food security and the affordability of diverse foods, may help increase the proportion of children who achieve a minimum acceptable diet. Declarations Ethics approval and consent to participate The ethical clearance was obtained from the College of Agricultural and Environmental Sciences Research and Ethics Committee, Makerere University in accordance with the Declaration of Helsinki. Permission was also obtained from the leadership of the Local Government in Kanungu District, Uganda. Before study participants were enrolled on this study, we ensured that they fully understood the study procedures and their right to withdraw at will, without repercussion. In addition, each participant signed a consent form to register their informed consent. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding Authors’ contributions GA: Conceptualization, methodology, data analysis, development of the initial draft, review and editing; CT: Conceptualization, methodology, data collection, data curation, manuscript review; EK: Conceptualization, data curation, methodology and writing and manuscript review. The three authors have read and approved the final version of the manuscript. Acknowledgements The authors appreciate the Department of Food Technology and Nutrition, Makerere University, for providing technical support and field materials. We are grateful to the caregivers and households in Eastern Ward who generously gave their time and information. 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Additional Declarations No competing interests reported. Supplementary Files QuestionnaireDeterminatsofacceptablediet.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 06 May, 2026 Reviews received at journal 05 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviews received at journal 07 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor assigned by journal 07 Apr, 2026 Editor invited by journal 06 Apr, 2026 Submission checks completed at journal 06 Apr, 2026 First submitted to journal 06 Apr, 2026 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. 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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-9168381","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621619496,"identity":"f1e4578a-7656-4b39-bdd9-e9a5b6ab1849","order_by":0,"name":"Gaston Ampe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBADOXn2BiBlYEGk+gMMDMaGPQdAWiSI15LYcCMBxCRCC/+0s4c/f6i4w9g48/nVDT8KJBj427sT8GqRuJ2XJnHgzDNmdumcsps9QIdJnDm7Ab81t3PMGA62HWZjnJ2TdoMHqMVAIhe/FvnbOcYfgFp4GG6eSbv5hxgtBrdzDCSAWiQYbrAfu02ULYYgv5w5c9jAsCeH7baMgQQPQb/I3c49/KGi4nD9fPbjz26++WMjx9/eS8D7DDxwhgEKlxgt7A+IUD0KRsEoGAUjEQAAFjpNMx1HC1YAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"Gaston","middleName":"","lastName":"Ampe","suffix":""},{"id":621619497,"identity":"06708f7c-6d10-4514-9576-f5c8e9bfba72","order_by":1,"name":"Chrispus Tumwebaze","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Chrispus","middleName":"","lastName":"Tumwebaze","suffix":""},{"id":621619498,"identity":"75671924-e880-4ea9-bf8f-76c3f2c9a144","order_by":2,"name":"Edward Kansiime","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"","lastName":"Kansiime","suffix":""}],"badges":[],"createdAt":"2026-03-19 10:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9168381/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9168381/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109202995,"identity":"38b2f47c-ad2a-463c-b01c-6b703731b8c5","added_by":"auto","created_at":"2026-05-13 14:20:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":376731,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9168381/v1/0c9ec350-792c-46da-97b7-670b13163aaa.pdf"},{"id":106816230,"identity":"afdafb9d-e8f2-4e10-bf42-b7302fa23034","added_by":"auto","created_at":"2026-04-13 17:25:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":29634,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireDeterminatsofacceptablediet.docx","url":"https://assets-eu.researchsquare.com/files/rs-9168381/v1/db1593041fa1b689936c02aa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eMinimum dietary diversity (MDD) for children 6\u0026ndash;23 months is defined as consuming foods from at least five of eight food groups in the previous 24 hours and is an indicator for micronutrient adequacy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Minimum meal frequency (MMF) refers to receiving, in the previous 24 hours, at least two feeds for breastfed infants 6\u0026ndash;8 months, at least three feeds for breastfed children 9\u0026ndash;23 months, and at least four feeds for non-breastfed children 6\u0026ndash;23 months being an indicator for energy adequacy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A child meets the minimum acceptable diet (MAD) if both MDD and MMF are achieved.\u003c/p\u003e \u003cp\u003eAdequate complementary feeding during this period supports linear growth, cognitive development, school performance, immune function and later-life productivity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In contrast, not meeting MAD contributes to undernutrition with long-term consequences, including heightened risk of metabolic disease and reduced work capacity in adulthood [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildren aged 6\u0026ndash;23 months are particularly vulnerable because they are shifting from exclusive breastfeeding to family foods, and breast milk alone no longer provides all required nutrients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Barriers to optimal infant and young child feeding (IYCF) are multifaceted and include caregiver knowledge and cultural norms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], household poverty [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], caregiver education and income, access to productive assets such as gardens and livestock [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], household size, and the ages of both caregiver and child [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Improving dietary diversity in particular often depends on a more diverse local food system, social support, and women\u0026rsquo;s empowerment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally, malnutrition remains a major driver of under-five morbidity and mortality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In Uganda, undernutrition remains a significant public health challenge; national surveys have documented substantial levels of stunting and underweight among children under five [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The Ministry of Health has also highlighted that complementary feeding remains suboptimal, with a very low still declining proportion of children consuming diets that meet MDD (18%) and MAD (14%) in 2016 reducing further to 10% (MDD) and 7% (MAD) in 2022 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While secondary analyses of national survey data have identified predictors of MDD and MMF at the national level [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], less is known about the determinants of MAD in specific local settings, where context-specific drivers may differ.\u003c/p\u003e \u003cp\u003eThis study therefore aimed to assess the determinants of minimum acceptable diet among children aged 6\u0026ndash;23 months in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting and design\u003c/h2\u003e \u003cp\u003eThe study took place in Eastern Ward of Buhoma Town Council in Kanungu District, south-western Uganda. Eastern Ward comprises the villages of Nyakeina, Rubona, Kyumbugushu, Iraro, Kashebeya and Kakarati. The area is hilly, with much of the population living on hill plateaus. Most residents rely on agriculture, including tea cultivation and subsistence farming, with additional income opportunities linked to tourism around Bwindi Impenetrable National Park.\u003c/p\u003e \u003cp\u003e We used a community-based cross-sectional analytical design, enrolling caregivers of children aged 6\u0026ndash;23 months who resided in Eastern Ward. A household member was defined as someone who had stayed in the household for at least 30 days prior to the study. In households where more than one eligible child was present, one was selected using simple random sampling.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling and sample size\u003c/h3\u003e\n\u003cp\u003eSystematic sampling was used. A sampling frame of eligible children was compiled, a random start was chosen, and then every nth child was selected according to the sampling interval.\u003c/p\u003e \u003cp\u003eThe required sample size was estimated using the Cochran formula as adapted from Singh and Masuku [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;Z\u0026sup2;PQ / e\u0026sup2;\u003c/p\u003e \u003cp\u003ewhere Z is the critical value corresponding to a 95% confidence level, P is the estimated prevalence (85% in the original calculation), Q\u0026thinsp;=\u0026thinsp;1\u0026thinsp;\u0026minus;\u0026thinsp;P, and e is the desired precision (5%). This yielded a target sample size of 196.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected using an interviewer-administered structured questionnaire together with a 24-hour dietary recall. The data collection tool had been specifically designed for this study. The tools were translated from English into a local language called Runyankore\u0026ndash;Rukiga to improve comprehension.\u003c/p\u003e\n\u003ch3\u003eOutcome variable: minimum acceptable diet (MAD)\u003c/h3\u003e\n\u003cp\u003eMAD was determined from the 24-hour recall of all foods and beverages consumed by the child. MDD and MMF were first computed and then combined.\u003c/p\u003e \u003cp\u003eFor MDD, foods were grouped into eight categories:1 breast milk; 2 grains, roots and tubers; 3 legumes and nuts; 4 dairy products; 5 flesh foods; 6 eggs; 7 vitamin A-rich fruits and vegetables; and 8; other fruits and vegetables. A child met MDD if they consumed foods from at least five of these eight groups.\u003c/p\u003e \u003cp\u003eFor MMF, we counted the eating occasions of solid, semi-solid or soft foods in the previous 24 hours and compared it with age- and breastfeeding-status-specific thresholds: at least two times for breastfed children 6\u0026ndash;8 months; at least three times for breastfed children 9\u0026ndash;23 months; and at least four times for non-breastfed children 6\u0026ndash;23 months. A child was classified as having met MAD if they met both MDD and MMF; otherwise they were classified as not meeting MAD.\u003c/p\u003e\n\u003ch3\u003eExplanatory variables\u003c/h3\u003e\n\u003cp\u003eChild-level variables included age, sex, birth order, whether breastfeeding was initiated within 1 hour of birth, receipt of prelacteal feeds, and current breastfeeding status. Caregiver-level variables included age, marital status, weekly earnings, highest education level, work status, and whether they had ever received IYCF counselling. Household-level variables included food security status, household size, and family type.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eNutrition knowledge\u003c/h2\u003e \u003cp\u003eCaregiver IYCF knowledge was assessed with a 13-item scale adapted from FAO KAP guidance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Each correct response scored 1 point and each incorrect response 0, for a maximum of 13. Scores were categorized as sufficient (\u0026ge;\u0026thinsp;7) or insufficient (0\u0026ndash;6).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHousehold food security\u003c/h3\u003e\n\u003cp\u003eHousehold food security was assessed using the Household Food Insecurity Access Scale (HFIAS) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. As applied in this study, households that responded \u0026ldquo;yes\u0026rdquo; to any of questions 2\u0026ndash;9 were categorized as food insecure.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eOf the 196 targeted participants, 147 caregivers were interviewed. Eleven questionnaires were invalid, leaving 126 for analysis. Data were coded and entered, and analysis was conducted using SPSS version 20.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarize child, caregiver and household characteristics. Bivariate analyses using chi-square tests assessed associations between independent variables and MAD, and crude odds ratios (COR) were calculated. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 or those considered conceptually important were entered into a multiple logistic regression model. Backward stepwise elimination was used to identify independent determinants of MAD. Model fit was assessed with the Hosmer-Lemeshow goodness-of-fit test. In the final model, variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were retained, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eAmong the 126 children included in the analysis, 39.7% were aged 6\u0026ndash;8 months and 60.3% were aged 9\u0026ndash;23 months. Slightly more than half (54.8%) were female. Most children (61.9%) were first-born. Breastfeeding was initiated within the first hour after birth for 69.0% of children. Prelacteal feeds were not given to 75.4%. At the time of the survey, 62.7% of children were still breastfeeding.\u003c/p\u003e \u003cp\u003e Most caregivers were 20\u0026ndash;35 years old (54.0%) and married (70.6%). Weekly earnings were less than USD 8 for 52.4% of caregivers. A small proportion had tertiary education or higher (9.5%). About half (50.8%) were engaged in work.\u003c/p\u003e \u003cp\u003eRegarding households, 45.2% were food insecure, and just over half (56.3%) had 3\u0026ndash;5 members as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of respondents (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 6\u0026ndash;8 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 9\u0026ndash;23 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order: first\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order: second\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order: third and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast initiation within 1 hour: yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast initiation within 1 hour: no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrelacteals: yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrelacteals: no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding: yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding: no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregiver characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 20\u0026ndash;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 36\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings \u0026lt;\u003cspan\u003e$\u003c/span\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings \u003cspan\u003e$\u003c/span\u003e8\u0026ndash;\u003cspan\u003e$\u003c/span\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings \u003cspan\u003e$\u003c/span\u003e28\u0026ndash;\u003cspan\u003e$\u003c/span\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings \u0026gt;\u003cspan\u003e$\u003c/span\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: never gone to school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: tertiary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood security status: yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood security status: no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHH size 1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHH size 3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHH size\u0026thinsp;\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCaregiver knowledge toward IYCF practices\u003c/h2\u003e \u003cp\u003eMost caregivers knew that breastfeeding should continue until 2 years of age (75.4%), that the first food for a newborn should be breast milk only (72.2%), and that breastfeeding should be initiated within 1 hour after birth (67.5%). Knowledge was weaker for topics related to anaemia: only 17.5% correctly identified causes of anaemia and 24.6% recognized signs of iron-deficiency anaemia. Overall, 65.9% of caregivers had insufficient IYCF knowledge based on the 13-item score as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportion of caregivers answering \u0026ldquo;Yes\u0026rdquo; to knowledge statements (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst food for a newborn is breast milk only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding should be initiated within 1 hour after birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild\u0026thinsp;\u0026lt;\u0026thinsp;6 months should be breastfed on demand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpressed breast milk should be fed to child in mother\u0026rsquo;s absence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCessation of breastfeeding is at 2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild should be breastfed on-demand after weaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA child could be weaned at 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild 6\u0026ndash;8 months should be fed at least twice a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild 9\u0026ndash;23 months should be fed three or more times a day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere are 8 food groups a child\u0026rsquo;s meal should be planned with\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware of signs of iron-deficiency anaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware of causes of anaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient knowledge (\u0026ge;\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eProportion meeting MMF, MDD and MAD\u003c/h2\u003e \u003cp\u003eOverall, 89.7% of children met MMF, indicating that most were being fed often enough according to age and breastfeeding status. However, only 21.4% met MDD, and consequently just 18.3% met MAD. Subgroup figures and one of the original graphs were internally inconsistent with the reported overall totals; therefore, only the clearly stated overall prevalence values are presented here.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with meeting MAD (bivariate analysis)\u003c/h2\u003e \u003cp\u003eMeeting MAD was significantly associated with birth order (third and above), weekly earnings, education level, household food security status, and caregiver nutrition knowledge (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. No significant associations were found for child age, sex, breastfeeding initiation, prelacteal feeding, breastfeeding status, maternal age, marital status, work status, IYCF counselling, household size or family status (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with MAD from bivariate model (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild age (6\u0026ndash;8 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.172\u0026ndash;1.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.568\u0026ndash;3.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order (third and above)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.43\u0026ndash;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast initiation (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.482\u0026ndash;3.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrelacteal use (no)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.278\u0026ndash;2.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreastfeeding status (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.359\u0026ndash;2.301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (\u0026lt;\u0026thinsp;18 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.034\u0026ndash;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status (married)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u0026ndash;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings (\u003cspan\u003e$\u003c/span\u003e28\u0026ndash;\u003cspan\u003e$\u003c/span\u003e55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.33\u0026ndash;4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level (tertiary)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.897\u0026ndash;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork status (working)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.533\u0026ndash;3.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIYCF counselling (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.287\u0026ndash;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood security (food secure)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.074\u0026ndash;22.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHH size (1\u0026ndash;2 members)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64\u0026ndash;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily status (nuclear)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u0026ndash;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition knowledge (sufficient)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.251\u0026ndash;7.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of meeting MAD (multivariable analysis)\u003c/h2\u003e \u003cp\u003eIn the final logistic regression model, determinants of meeting MAD included birth order, weekly earnings, household food security status, and caregiver nutrition knowledge as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eMultiple logistic regression for determinants of MAD (n\u0026thinsp;=\u0026thinsp;126)\u003c/b\u003e \u003cem\u003e(Presented as in the source document; confidence interval lower bounds recorded as 0.000 in the source appear to reflect rounding/output issues and should be replaced with exact SPSS output values during final journal preparation.)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI (Lower\u0026ndash;Upper)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild age: 6\u0026ndash;8 months (ref: 9\u0026ndash;23 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u0026ndash;2.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order: second (ref: first)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.034\u0026ndash;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth order: third and above (ref: first)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.32\u0026ndash;6.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings: \u003cspan\u003e$\u003c/span\u003e8\u0026ndash;\u003cspan\u003e$\u003c/span\u003e28 (ref: \u0026gt;\u003cspan\u003e$\u003c/span\u003e55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u0026ndash;0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings: \u003cspan\u003e$\u003c/span\u003e28\u0026ndash;\u003cspan\u003e$\u003c/span\u003e55 (ref: \u0026gt;\u003cspan\u003e$\u003c/span\u003e55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u0026ndash;0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly earnings: \u0026lt;\u003cspan\u003e$\u003c/span\u003e8 (ref: \u0026gt;\u003cspan\u003e$\u003c/span\u003e55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u0026ndash;0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: secondary (ref: tertiary and above)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u0026ndash;23.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: primary (ref: tertiary and above)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u0026ndash;17.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation: never gone to school (ref: tertiary and above)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u0026ndash;13.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork status: working (ref: not working)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.22\u0026ndash;9.842\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIYCF counselling: yes (ref: no)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u0026ndash;3.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood security: food insecure (ref: food secure)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.6\u0026ndash;2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHH size: 1\u0026ndash;2 (ref: \u0026gt;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.085\u0026ndash;12.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHH size: 3\u0026ndash;5 (ref: \u0026gt;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.021\u0026ndash;5.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily status: single mother/father (ref: extended)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u0026ndash;1.296\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily status: nuclear (ref: extended)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.169\u0026ndash;2.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition knowledge: sufficient (ref: insufficient)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.67\u0026ndash;6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBirth order\u003c/h2\u003e \u003cp\u003eChildren who were third-born or later had higher odds of meeting MAD compared with first-born children. This may reflect greater caregiver experience with infant feeding and possible modelling or influence from older siblings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eWeekly earnings\u003c/h2\u003e \u003cp\u003eCompared to caregivers with the highest weekly earnings (\u0026gt;\u0026thinsp;USD 55), those in lower earning categories had substantially reduced odds of meeting MAD, indicating that economic constraints likely limit the ability to purchase and provide a diverse range of complementary foods.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eHousehold food security\u003c/h2\u003e \u003cp\u003eChildren in food-secure households were more likely to meet MAD than those in food-insecure households, consistent with the idea that reliable access to sufficient food enhances both meal frequency and dietary diversity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eCaregiver nutrition knowledge\u003c/h2\u003e \u003cp\u003eChildren whose caregivers had sufficient IYCF knowledge had higher odds of meeting MAD than those whose caregivers had insufficient knowledge. Better knowledge may support more appropriate choices regarding both the variety and frequency of foods offered.\u003c/p\u003e \u003cp\u003eSome variables, such as education level, showed significance in bivariate analysis but became non-significant in the multivariable model. This may be due to overlap between education, income, and other contextual factors, or limited variation in occupations and income sources in the study setting.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed prevalence and determinants of MAD among children 6\u0026ndash;23 months in Eastern Ward, Buhoma Town Council. The study found that fewer than one in five children aged 6\u0026ndash;23 months, met the minimum acceptable diet, even though almost nine in ten met the minimum meal frequency which reflects national studies as already reported [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The main limiting factor was dietary diversity, echoing national and regional findings that children often eat frequently but from a narrow range of foods.\u003c/p\u003e \u003cp\u003eThe association between higher birth order and increased likelihood of meeting MAD suggests that caregivers may become more confident and skilled in feeding with subsequent children, or that older siblings influence the younger child\u0026rsquo;s exposure to a wider variety of foods [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, this pattern could also be shaped by other household dynamics and warrants further exploration.\u003c/p\u003e \u003cp\u003eLower weekly earnings were strongly associated with lower odds of meeting MAD, consistent with studies from other low- and middle-income settings showing that income and overall socioeconomic status are key determinants of dietary diversity and diet quality [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. When financial resources are limited, caregivers may prioritize staple foods and forego more diverse, often more expensive, animal-source foods, fruits and vegetables.\u003c/p\u003e \u003cp\u003eHousehold food security emerged as another important determinant. Food-insecure households may experience seasonal shortages, rely heavily on a limited set of staples, and have fewer options for achieving dietary diversity. These constraints can affect both meal frequency and diversity, but in this setting appear to have had a particularly marked impact on diversity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCaregiver nutrition knowledge was also a significant determinant of MAD. Caregivers who understood the recommended feeding frequency and the need to include multiple food groups, and who were aware of the consequences of micronutrient deficiencies, were more likely to meet MAD with their children. This underscores the value of well-designed IYCF counselling and practical, context-specific nutrition education delivered through health facilities, community health workers and other community platforms.\u003c/p\u003e \u003cp\u003eEducation level was associated with MAD in bivariate analysis but not in the adjusted model. One possible explanation is that, within this community, opportunities for income generation and access to food may not differ greatly by education level, particularly where agriculture, tea growing and tourism dominate livelihoods.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe prevalence of minimum acceptable diet among children aged 6\u0026ndash;23 months in Eastern Ward, Buhoma Town Council, was low. Despite most children being fed often enough, their diets lacked sufficient diversity. Key determinants of meeting MAD included higher birth order, greater weekly earnings, household food security and sufficient caregiver nutrition knowledge.\u003c/p\u003e \u003cp\u003eEfforts to improve complementary feeding in this setting should go beyond general messaging to focus on practical ways families can diversify children\u0026rsquo;s diets using locally available foods, while maintaining appropriate feeding frequency. Programs should prioritize poorer and food-insecure households and provide targeted support for first-time mothers and caregivers. Strengthening community nutrition education and social behaviour change communication, alongside broader interventions aimed at improving household food security and the affordability of diverse foods, may help increase the proportion of children who achieve a minimum acceptable diet.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical clearance was obtained from the College of Agricultural and Environmental Sciences Research and Ethics Committee, Makerere University in accordance with the Declaration of Helsinki. Permission was also obtained from the leadership of the Local Government in Kanungu District, Uganda. Before study participants were enrolled on this study, we ensured that they fully understood the study procedures and their right to withdraw at will, without repercussion. In addition, each participant signed a consent form to register their informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGA: Conceptualization, methodology, data analysis, development of the initial draft, review and editing; CT: Conceptualization, methodology, data collection, data curation, manuscript review; EK: Conceptualization, data curation, methodology and writing and manuscript review. The three authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate the Department of Food Technology and Nutrition, Makerere University, for providing technical support and field materials. We are grateful to the caregivers and households in Eastern Ward who generously gave their time and information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSekartaji R, Suza DE, Fauziningtyas R, Almutairi WM, Susanti IA, Astutik E, et al. Dietary diversity and associated factors among children aged 6\u0026ndash;23 months in Indonesia. J Pediatr Nurs. 2021;56:30\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMekonnen TC, Workie SB, Yimer TM, Mersha WF. Meal frequency and dietary diversity feeding practices among children 6\u0026ndash;23 months of age in Wolaita Sodo town, Southern Ethiopia. J Health Popul Nutr. 2017;36:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolla A, Egata G, Getacher L, Kebede B, Sayih A, Arega M, et al. Minimum acceptable diet and associated factors among infants and young children aged 6\u0026ndash;23 months in Amhara region, Central Ethiopia: community-based cross-sectional study. BMJ Open. 2021;11(5):e044284.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWelelaw M. Minimum acceptable diet practice and associated factors among 6\u0026ndash;23 months children in households with irrigated and non-irrigated users of North Mecha District, Northwest Ethiopia, 2021. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartins VJ, Toledo Flor\u0026ecirc;ncio TM, Grillo LP, Franco MCP, Martins PA, Clemente APG, et al. Long-lasting effects of undernutrition. Int J Environ Res Public Health. 2011;8(6):1817\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbeshu MA, Lelisa A, Geleta B. Complementary feeding: review of recommendations, feeding practices, and adequacy of homemade complementary food preparations in developing countries\u0026mdash;lessons from Ethiopia. Front Nutr. 2016;3:41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNankumbi J, Muliira JK. Barriers to infant and child-feeding practices: a qualitative study of primary caregivers in rural Uganda. J Health Popul Nutr. 2015;33(1):106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIssaka AI, Agho KE, Burns P, Page A, Dibley MJ. Determinants of inadequate complementary feeding practices among children aged 6\u0026ndash;23 months in Ghana. Public Health Nutr. 2015;18(4):669\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaruvinga A, Muchenje V, Mushunje A. Determinants of rural household dietary diversity: the case of Amatole and Nyandeni districts, South Africa. Int J Dev Sustain. 2013;2(4):2233\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAber H, Kisakye AN, Babirye JN. Adherence to complementary feeding guidelines among caregivers of children aged 6\u0026ndash;23 months in Lamwo district, rural Uganda. Pan Afr Med J. 2018;31(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchodigni IM, Amoussa Hounkpatin W, Ntandou-Bouzitou G, Avohou H, Termote C, Kennedy G, et al. Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6\u0026ndash;23 months in Southern Benin. Food Secur. 2017;9:1117\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabaasa G. An investigation on factors associated with malnutrition among under-five children in Nakaseke and Nakasongola districts, Uganda. BMC Pediatr. 2015;15(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFenta HM, Workie DL, Zike DT, Taye BW, Swain PK. Determinants of stunting among under-five years children in Ethiopia from the 2016 Ethiopia demographic and Health Survey: application of ordinal logistic regression model using complex sampling designs. Clin Epidemiol Glob Health. 2020;8(2):404\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUganda Bureau of Statistics. Uganda Demographic and Health Survey (UDHS) 2016. Uganda: UBOS.: Kampala; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health (Uganda). Guidelines on Maternal, Infant, Young Child and Adolescent Nutrition. Kampala, Uganda: Ministry of Health; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScarpa G, Berrang-Ford L, Galazoula M, Kakwangire P, Namanya DB, Tushemerirwe F, et al. Identifying predictors for minimum dietary diversity and minimum meal frequency in children aged 6\u0026ndash;23 months in Uganda. Nutrients. 2022;14(24):5208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh AS, Masuku MB. Sampling techniques \u0026amp; determination of sample size in applied statistics research: an overview. Int J Econ Commer Manag. 2014;2(11):1\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmoah AN, Danquah AO, Stanislav TS, Drokow EK, Yacong B, Wang L et al. Correlates of dietary diversity among children aged 6\u0026ndash;23 months of head porters in Ghana. Front Public Health 2022;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoates J, Swindale A, Bilinsky P. \u003cem\u003eHousehold Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide. Version 3.\u003c/em\u003e 2007.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossiter MD, Richard B, Whitfield KC, Mann L, McIsaac JLD. Responsive feeding values and practices among families across the Canadian Maritime provinces. Appl Physiol Nutr Metab. 2022;47(5):495\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyre SK, White MJ, Harris HA, Byrne RA. I\u0026rsquo;m having jelly because you\u0026rsquo;ve been bad!\u0026rsquo;: A grounded theory study of mealtimes with siblings in Australian families. Matern Child Nutr. 2023;19(2):e13484.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVictor R, Baines SK, Agho KE, Dibley MJ. Factors associated with inappropriate complementary feeding practices among children aged 6\u0026ndash;23 months in Tanzania. Matern Child Nutr. 2014;10(4):545\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoshi N, Agho KE, Dibley MJ, Senarath U, Tiwari K. Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary data analysis of Demographic and Health Survey 2006. Matern Child Nutr. 2012;8:45\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRohner F, Bradley AW, Grant JA, et al. Infant and young child feeding practices in urban Philippines and their associations with stunting, anemia, and deficiencies of iron and vitamin A. Food Nutr Bull. 2013;34(2 Suppl 1):S17\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"minimum acceptable diet, minimum dietary diversity, minimum meal frequency, complementary feeding, infant and young child feeding","lastPublishedDoi":"10.21203/rs.3.rs-9168381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9168381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChildren aged 6\u0026ndash;23 months are particularly vulnerable to undernutrition, as breast milk alone can no longer meet their nutritional needs, and as such, the quality and quantity of the complementary foods they eat become critical. To assess whether a child in this age group is being fed adequately, researchers and health programmes use a composite indicator called minimum acceptable diet (MAD), which includes two variables: how often a child is fed (minimum meal frequency, MMF) and how diverse their diet is (minimum dietary diversity, MDD).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a community-based cross-sectional analytical study among caregivers of children aged 6\u0026ndash;23 months living in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda. Data were collected using an interviewer-administered questionnaire capturing socio-demographic characteristics, infant and young child feeding (IYCF) knowledge, household food security, and a 24-hour dietary recall. MAD was defined based on whether the child met both MDD and MMF. Household food security was measured using the Household Food Insecurity Access Scale (HFIAS). Nutrition knowledge was assessed with a 13-item scale and categorized as sufficient (\u0026ge;\u0026thinsp;7) or insufficient (0\u0026ndash;6). We used chi-square tests and crude odds ratios (COR) for bivariate analysis, and multiple logistic regression to identify independent determinants of MAD, with statistical significance set at 5%.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 196 targeted participants, 147 caregivers were interviewed, and 126 questionnaires were valid for analysis. Overall, 89.7% of children met MMF, 21.4% met MDD, and 18.3% met MAD. In multivariable analysis, key determinants of meeting MAD were birth order (being third-born or later), higher weekly earnings, household food security, and sufficient caregiver nutrition knowledge.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe proportion of children aged 6\u0026ndash;23 months who met MAD in Eastern Ward was low, largely driven by poor dietary diversity despite most children receiving meals frequently enough. Interventions to improve complementary feeding should combine community-based nutrition education and social behaviour change approaches with efforts to enhance household food security and access to affordable, diverse foods.\u003c/p\u003e","manuscriptTitle":"Determinants of minimum acceptable diet among children aged 6–23 months in Eastern Ward, Buhoma Town Council, Kanungu District, Uganda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 17:24:49","doi":"10.21203/rs.3.rs-9168381/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T03:22:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T10:50:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T07:42:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162334135490703411985984491893214847563","date":"2026-04-16T12:48:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61345419625703866972084055801635167634","date":"2026-04-09T09:07:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-07T15:42:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211907641472323080707736203654512475814","date":"2026-04-07T15:09:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T07:27:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-07T07:21:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T11:19:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T09:42:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2026-04-06T09:15:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d21899c-8ef5-4ffd-b01b-847aa386f737","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T03:22:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T10:50:33+00:00","index":74,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T07:42:25+00:00","index":72,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T03:38:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 17:24:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9168381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9168381","identity":"rs-9168381","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}