Complementary feeding practices in Northern Ghana: a mixed-methods study of prevalence, predictors, and...

Inappropriate complementary feeding (CF) practices contribute significantly to poor child development especially in malnutrition-burdened areas. While high knowledge and poor CF practices are widely documented, socio-cultural norms and taboos influencing child feeding practices have rarely been studied in context. This study examined the prevalence, predictors, and cultural beliefs influencing CF practices in Northern Ghana.

A concurrent mixed-methods approach was employed. 326 mothers with children aged 6-23 months were recruited into the quantitative study while four Focus Group Discussions (FGDs) were held for the qualitative study. Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyze the quantitative data (using both descriptive and inferential statistics) while the qualitative data was analyzed using thematic analysis.

About 66.6% of the children were timely initiated to CF (introduction of solid, semisolid or soft foods at 6-8 months), while 39.3%, 71.2%, and 37.1% met minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD), respectively. Appropriate complementary feeding (those who achieved timely initiation to CF, MDD, and MMF simultaneously) was met by 22.1%. Antenatal care (ANC) attendance and ethnicity were significant determinants of timely initiation of CF; children's age and ethnicity were predictors of MAD; while household size and children's age were associated with appropriate CF. In the qualitative results, early CF initiation (before 6th month of birth) was driven by perceived child readiness, and influence from mothers-in-law. Consumption of meat, eggs and dairy products were restricted by food taboos as well as spiritual and cultural beliefs. It was believed that consumption of these foods may cause delayed speech or immoral behavior in children. These beliefs restricted mothers' willingness to provide animal-source foods.

Appropriate complementary feeding remains sub-optimal despite high rate of timely CF initiation. These feeding practices are influenced by a wide range of maternal, household, and socio-cultural factors. These findings highlight the importance of considering socio-demographic and cultural influences when designing future child nutrition programs and interventions.