Inappropriate supplementary feeding techniques put children under the age of two at danger of malnutrition, illness, and death (8). To avert the dire consequences this might have on young children, the WHO has developed recommendations for Infant and Young Child Feeding practices for children aged 6–23 months, including MDD as one of the core eight indicators (4). In our study, we assessed the MDD and associated factors among children aged 6–23 months in the Hohoe Municipality, in the Volta Region of Ghana. Finding from the study revealed that only 17.1% (72 children) had achieved minimal dietary diversity within 24 hours preceding the study. This proportion contrasts with earlier studies in India and Ethiopia (7, 17, 18, 27), as well as Burkina Faso (28), where higher percentages were reported. However, in comparison to studies in Pakistan (29), India (30), (Sri Lanka, Nepal, and Bangladesh) (18), Ethiopia (31), Nigeria (32), Tanzania (33), and Ghana (14, 34), the current study's findings indicate a relatively lower prevalence of MDD. The observed variations in MDD rates among children could be attributed to a complex interplay of cultural, socioeconomic, geographical, and healthcare-related factors, as well as differences in data collection methods across the different studies in these regions.
This study revealed that a substantial majority of mothers, specifically 374 (88.6%), reported providing breast milk to their children within the past 24 hours. Conversely, the consumption of eggs in the previous 24 hours was reported by only 127 (30.1%) mothers. Notably, a significant proportion of 250 (59.2%) mothers offered their children foods such as grains, roots, or tubers within the same timeframe. In comparison, a study carried out in Ethiopia documented a comparatively elevated percentage (35). The difference in feeding practices among mothers can be attributed to a combination of cultural, economic, knowledge-based, and contextual factors that shape dietary choices for their children which could have contributed to the observed variations in these populations.
Additionally, the study reported a low consumption of Vitamin-A rich vegetables and fruits 387 (91.7%) among children aged 6–23 months. This could potentially be attributed to the prohibitively high cost, rendering them inaccessible to individuals residing in economically challenged households in Ghana. Additionally, caregivers might lack the necessary knowledge on effectively incorporating these essential dietary components into meals, highlighting the need for educational interventions, as emphasized in a study by (36). When contrasted with earlier studies conducted in Central America (37), Uttar Pradesh (38), Ethiopia (39), and Ghana (34), the pattern of diminished consumption of vegetables and fruits remained consistent.
An additional finding from this study revealed that a substantial majority 343 (80.3%) of mothers exhibited a good dietary practice for their children. In comparison to earlier research, this particular finding outperformed the results of a study conducted in Ethiopia (35). The disparity observed between the two different regions can be attributed to cultural and dietary distinctions, varying economic conditions, differences in nutritional awareness and education, government policies, food availability, sample characteristics, and methodological variations.
According to our study, educational level of mothers had a significant association with MDD of children. Children whose mothers had obtained tertiary education were 3 times more likely to have acquired a high MDD thus consuming 4 or more food items from the 7 MDD food groups compared to the children of mothers with low level of education [aOR = 3.16 (95% CI: 0.75–13.29), p = 0.001]. This aligns with similar findings from researches conducted in Uttar Pradesh (38), Nepal (40), Sri Lanka (41), and Ethiopia (7, 18). This correlation can be explained by the fact that mothers with higher education levels often have better access to information about nutrition and child care, enabling them to make informed decisions about their children's diets. Additionally, higher education may enhance mothers' ability to understand the nutritional needs of their infants and incorporate a wider variety of foods into their diets. Educated mothers are more likely to engage in health-seeking behaviors and adhere to recommended feeding practices, contributing to the observed positive outcomes in MDD. The consistency of these findings across the different regions and cultures underscores the universal importance of maternal education in fostering optimal infant feeding practices and ultimately promoting child health and development.
Furthermore, our study uncovered a noteworthy correlation between ethnicity and high MDD. The likelihood of a child, whose mother identified with different ethnic groups (such as Krobo or Kusasi), achieving a high MDD was found to be 25 times greater in comparison to mothers from Ewe, Akan, Guan, or Ga-Adamgbe ethnic backgrounds [aOR = 24.72 (1.43–15.64), p = 0.011]. This finding aligns with a prior study conducted in Nepal, which demonstrated that children from (Dalits and Janajati) ethnic groups had a higher odds ratio of not meeting the MDD compared to those from the (Brahmin/Chhetri) ethnic group (42). Similarly, another study in Nepal indicated that children from the (Brahmin/Chhetri) ethnic group were more likely to receive a variety of food groups compared to those from other caste/ethnic groups (40). The reason for the correlation across these studies can be attributed to the distinct cultural and dietary practices among different ethnic groups, varying levels of access to nutritional resources, traditional knowledge of locally available nutritious foods, socioeconomic influences, differences in healthcare access and education, geographical availability of diverse foods, as well as the impact of public health interventions.
Implications for policy and practice
The current study highlights the need for the integration of nutrition counseling and guidance within routine antenatal (ANC) and postnatal (PNC) care visits. This approach will ensure that mothers receive timely and accurate information on optimal feeding practices, starting from pregnancy through the early childhood years. The strong association between maternal education, ethnicity and children's dietary diversity highlights the need for educational interventions targeting mothers, especially those with lower levels of education as well as culturally sensitive interventions. Comprehensive public awareness campaigns can raise awareness about the importance of dietary diversity for child health and development. These campaigns can leverage various communication channels, including mass media, social media, community events, and local networks, to reach caregivers and influence positive behavior change. These interventions can be integrated into existing maternal and child health services to reach a wider audience. The implications drawn from this study emphasize the need for multifaceted and context-specific approaches to improve infant and young child feeding practices. By addressing them we can work together to promote optimal nutrition for children aged 6–23 months, contributing to better health outcomes and overall well-being.
Strengths and limitations of the study
The strength of the study lies in the utilization of the standardized tools and methodologies as well as the rigorous statistical analysis employed in the study. However, the study identified some limitations which must be acknowledged. The study's reliance on maternal recall of dietary practices over the past 24 hours introduces potential recall bias, as memory may not accurately capture all details, leading to underreporting or overestimation of certain food groups. Additionally, respondents may have provided answers that they perceived as socially desirable, potentially leading to an overestimation of positive feeding practices. Despite multivariate regression analysis, there may be unmeasured confounding factors not accounted for in the study that could influence the observed associations.