The prevalence of minimum acceptable diet child feeding practice in Lesotho was 22.71% [95%CI=0.1955 0.2622]. The prevalence was lower than that in Central Ethiopia (31.6%) and Nepal (30.1%), [28, 24]. It was higher than West Africa (11.56%), West Ethiopia (12.6%) and Northwest Ethiopia (8.6%) [29, 5].
Child age was a associated with MAD in this study. Children aged 9-23 months were more likely to meet the MAD compared to those aged 6-8 months. In many countries, less than one fourth of infants aged 6-23 months meet the criteria for dietary and feeding frequency [12]. Worku et al., (2022) in support indicated that, the reason why children are not meeting MAD requirements is because in most cases complementary feeding happens late, and the start of complementary feeding is commonly done with only limited items such as milk or cereal [29]. Late introduction of complementary feeding could also be attributed to the simultaneous occurrence of the eruption of teeth and the introduction of solid and semi-solid food [12]. The teething process typically leads to loss of appetite and negatively affecting the frequencies and diversity of meals [2]. Moreover, younger children are mainly breastfed, and their mothers might assume complementary feeding their younger children is not important as for older children, since older children usually have family meals [1, 34, 38]. Younger children are also likely to be introduced to complementary feeding late thus affecting the meal diversity and frequency [30, 31]. In Lesotho, complementary feeding is normally introduced too early or too late with insufficient diversity with more children eating cereal than other food types [32].
Sex of the child was also associated with MAD with girls more likely to receive MAD compared to boys. This was also reported in Southeast Ethiopia [33]. In the contrary, most studies found that boys had better dietary intake compared to girls [33, 34]. Hien et al., (2023) highlighted that, in some communities in Burkina Faso, there were gender preferences and children feeding by gender is common [34]. In Lesotho, being a boy from poor communities and rural areas is a great disadvantage than girls in the same environment when it comes to diets and access to education [35]. In Lesotho boys are often herding livestock from as young as three years [39]. This sociocultural phenomenon of herdboyship can lead to less care given to boy children from birth despite Lesotho being a patriarchal country. These herdboys are expected to live in isolation for months at a time despite their ages herding sheep and cattle and make their way home only twice a year in winter, so the animals could be checked, counted, and kept warm for a brief period [36].
At household level, maternal age was associated with MAD where children mothers were aged 20-25 and 35-39 were less likely to receive MAD compared to children whose mothers were aged 15-19 years. Children from the rest of the age groups (25-29, 30-34 and 40+) were equally likely to receive MAD compared to children whose mothers were aged 15-19 years. This means children to teenage mothers were no different from being fed MAD compared to most age groups. Teenage pregnancy in Lesotho remains a challenge [37]. The teenage pregnancy birth rates are high, estimated at 94 per 1000 girls aged 15-19 [37]. Teenage pregnancy is associated with several social and health risks and one of them is parental involvement [35, 37, 39]. Lack of parental involvement leaves grandparents with the problem of finding other ways to support their grandchildren [40]. The number of grandparents raising their grandchildren has increased significantly globally [41]. In 2010, 7 million grandmothers lived with their grandchildren globally, with 2.7 million grandparents responsible for the basic needs of one or more grandchildren [41]. Moreover, grandparents providing childcare are likely to be females, with a partner, with higher educational attainment and wealthier, thus increasing chances of children receiving MDD and MAD [42]. In China, grandparents were also more likely to support young mothers with children with appropriate mother and child feeding practices [43]. Breastfeeding support by grandmothers has been explored in Nepal, showing that grandmother’s involvement can promote and endorse positive health feeding practices [43]. In the United States, grandparents with knowledge about the importance of healthy diets can assist their grandchildren [43]. In support, children raised by grandparents and children of older mothers had higher odds of receiving MAD. In East Africa and Northwest Ethiopia, older aged women had high chances of providing MAD to their children compared to younger mothers [29]. Older mothers have experience on feeding practices and this might play a significant role in appropriate feeding practices [29, 42].
At community level, community poverty was a determinant of MAD, with children in communities with high community poverty less likely to meet the minimal dietary diversity and acceptable diet. Poverty, food insecurity and lower socio-economic status are considered as major challenges affecting feeding practices [44]. In India, Argentina, Indonesia, and Rwanda households with lower wealth quintiles were associated with unmet minimum dietary diversity [44, 45, 46, 47]. This is because poorest socioeconomic status families are unable to buy diverse food items [45]. In rural Rwanda, mothers highlighted that, poverty leads to reduced number of meals received by children, and they breastfeed children longer than they should to maximize food for the rest of the family [45]. Poverty also leads to food insecurity. Lindsay et al., (2012) highlighted that, household food insecurity is a critical variable for understanding the nutritional status in low-income populations [44]. Food insecurity is defined as the limited or uncertain availability of nutritionally adequate and safe foods which leads to poor diets [44]. Low food security also affects children through the reduced quality and variety of recommended diets [47]. Moreover, food security also occurs when nutritious food is not available to households because of areas they reside in [47]. Communities have different economic conditions that affect food availability, access and cultural preference which can influence food diversity in child feeding practices [46, 48]. On the other hand, Community Media Exposure was a determinant of MAD with children residing in communities with high community maternal media exposure more likely to receive MAD. In Lesotho, majority of households are exposure to mass media. The greater part of the population owns radios, with radio signal covering about 87% of the country, with most areas that are not covered are able to tune into radio stations in South Africa [49]. Mass media directly influences people’s behaviour because it is used to deliver health messages to promote social and behavioural change [50]. Zebodia and Atmaka (2021) highlighted that, mass media has a crucial role in educating mothers and caregivers on appropriate complementary feeding practices especially in the diversification of food [51]. Moreover, mass media is also associated with utilization of maternal health services like antenatal care, delivery in health facilities and appropriate feeding practices [27, 24]. In Indonesia, India, Nepal, Southern-Asia, East-Africa, Ethiopia, Bangladesh access to information from mass media was significantly associated with meeting recommended child feeding practices [52, 51, 27, 24, 31, 29]