Child malnutrition is a global emergency affecting every country in the world [1]. Globally, 151 children aged 0–59 months are stunted; 51 million wasted and 38.3 million have excess weight [1]. In sub-Saharan Africa, 39% of children are stunted; 28% wasted and 24% overweight [2]. According to the 2014 GDHS survey, 19% of Ghanaian children are stunted, 5% wasted, 11% underweight and about 3% are overweight [3]. The northern region of Ghana has the highest prevalence of stunting affecting 33% of children aged under 5 years.
A number of underlying factors could be contributing to the rising prevalence of malnutrition in children including poor access to health care, inadequate caring and feeding practices and poor sanitation [4]. Among these appropriate complementary feeding is very paramount and has been shown to improve nutrition status of children. Appropriate complementary feeding has been linked to optimal nutrition in infant and young children as it ensures their growth, health and development to attain their full potential. It’s been shown to reduce child morbidity and mortality thereby increasing child survival and protection [5, 6]. No wonder the WHO recommends that nutritionally adequate and safe complementary feeding should start from age 6 months with continued breastfeeding up to 2 years of age or beyond [5, 6].
According to the WHO three main indicators can be used to determine appropriate complementary feeding that include minimum meal frequency, diet diversity, adequate diet and continued breastfeeding [7, 8].
Evidence shows that appropriate complementary feeding rates in developing countries are less desirable and majority of infants and young children do not meet the minimum indicators for appropriate complementary feeding [9, 10]. Only 13% of Ghanaian children aged 6–23 months are fed a minimum acceptable diet [3]. Among a sample of 778 children aged 6–23 months from Northern Ghana, Saaka et al [11] found 57.3% of the children meeting the minimum meal frequency, 35.3% minimum dietary diversity score and 25% had minimum acceptable diet. In Nigeria, Udoh et al [12]found 31.5% of a sample of 330 children aged 6–23 months from Cross River State meeting minimum diet diversity, 36.5% minimum meal frequency and 7.3% received an acceptable diet. A community-based cross-sectional study among a sample of 506 children from North West Ethiopia found only 63% of the children receiving minimum meal frequency, 9.8% for minimum diet diversity and only 8.6% received the minimum acceptable diet [13].
A number of factors have been noted for the less optimal rates of appropriate complementary feeding including maternal education, income levels, antenatal attendance, spouse employment status, quality of institutional healthcare delivery, women empowerment in decision making, and among others [11, 13–15]. Notable among these factors is the mothers’ knowledge and attitudes towards recommended infant and young child feeding practices. There is evidence that high knowledge is associated with improved child feeding practices among mothers [15–17].
A few studies have investigated adequate diet and its determinants among infant and young children in Ghana. In our search of the literature we only came across three studies [11, 17, 18] that have investigated the core indicators of complementary feeding such as meal frequency, diet diversity, minimum adequate diet and their determinants among children aged 6–23 months. The Saaka et al [11] study that was conducted in Northern Ghana assessed the three indicators of appropriate complementary feeding but did not assess the knowledge and attitude of the mothers regarding infant and young child feeding practices. Gyampoh et al [17] investigated mothers knowledge regarding recommended infant and young child practices and its association with the practices but did not assess the mothers/care givers’ attitude towards child feeding practices and was also conducted in Accra, which differ socio-economically from Northern Ghana. Frempong and Annim [18] investigated dietary diversity and malnutrition in children using the Ghana Multiple Indicator Cluster Survey for 2011 but did not assess the other indicators of complementary feeding such as meal frequency and acceptable diet. Thus, there is limited data regarding the knowledge and attitudes of mothers on infant and young child feeding recommendations and how these are associated with child feeding practices in Northern Ghana and particularly the Kpandai District.
An understanding of the determinants of poor complementary feeding practices within a given context is a necessary step that should be taken to inform the design, planning and implementation of effective and sustainable interventions to improve the nutrition needs of children aged 6–23 months. The current study thus aims to evaluate the knowledge and attitudes of mothers regarding infant and young child feeding recommendations, child feeding practices and the determinants of adequate diet among children aged 6–23 months in the Kpandai district of the Northern Region of Ghana.