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Minimum Dietary Diversity and Associated Factors Among 6-23 Months Children in Ethiopia: A Systematic Review and
Melkamu Senbeta Jimma1,2, Dawit Getachew Assefa3, Muluwas Amentie Zelka4
1Center for Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation University of Technology Sydney Ultimo New South Wales Australia.
Abstract:
The 6-23-month period is a critical stage in child development, during which the transition from exclusive breastfeeding to complementary feeding increases the risk of nutritional deficiencies and related health problems. This study aimed to estimate the prevalence of minimum dietary diversity (MDD) and identify factors associated with MDD among children aged 6-23 months in Ethiopia. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Google Scholar, Embase, Health InterNetwork Access to Research Initiative (HINARI), Cochrane Library, and Web of Science were searched for studies published from April 1, 2018, to April 25, 2026. Study quality was assessed using the Newcastle-Ottawa Scale. Thirteen studies were included and analyzed in RStudio version 4. A random-effects model was used to estimate the pooled prevalence of MDD. Factors associated with MDD were synthesized narratively because of variable categorizations, directions of association, reference categories, and reporting of effect measures across studies. Subgroup analyses and an assessment of publication bias were also conducted. The review protocol was registered in PROSPERO (CRD42023415050). Thirteen studies involving 7194 participants were included. The pooled prevalence of minimum dietary diversity among Ethiopian children aged 6-23 months was 27% (95% CI: 21-33). Substantial between-study heterogeneity was observed (I 2 = 97.58%, p < 0.001; τ 2 = 0.01; Q(12) = 414.67, p < 0.001), indicating considerable variability in prevalence estimates across studies and warranting cautious interpretation. Among 13 studies that adjusted for confounders, child age, maternal education, use of antenatal and postnatal care, family size, and household wealth index were the most frequently reported as being significantly associated with MDD in the primary studies. In conclusion, despite observed heterogeneity, the prevalence of MDD remains low and below the WHO 2030 target. Strengthening maternal education, antenatal and postnatal care, and socioeconomic conditions may improve child nutrition and support progress toward Sustainable Development Goal 2.2 by 2030.
