Peer-reviewed article

Determinants of Infant and Young Child Feeding Practices of Children With Severe Acute Malnutrition in Agrarian and Pastoralist Settings of Ethiopia.

Areb M, Huybregts L, Tamiru D, Touré M, Biru B et al. · 1 Jul 2026

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study identified factors that influence infant and young child feeding practices among children aged 6-23 months with severe acute malnutrition in Ethiopia's agrarian and pastoralist regions. Caregiver literacy and dietary diversity were positively associated with children meeting minimum dietary diversity, while caregiver depression and food insecurity reduced the likelihood. The research found differences between settings, with pastoralist children more likely to achieve minimum dietary diversity but less likely to consume animal-source foods.

Key points

Minimum meal frequency was similar between settings (53.9% agrarian, 51.9% pastoralist), but minimum dietary diversity was higher in pastoralist areas (31.5% vs 19.0%)
Caregiver literacy was associated with higher likelihood of minimum meal frequency (IRR=1.21) and minimum dietary diversity (RR=2.04)
Caregiver depression reduced the likelihood of minimum meal frequency (RR=0.97) and minimum dietary diversity (RR=0.94)
Improved water source access was positively associated with minimum dietary diversity (RR=1.59)
Food insecurity and caregiver mobility restrictions were associated with reduced dietary diversity among children with severe acute malnutrition

Limitations

This is a cross-sectional baseline survey study without a comparison group, so causality cannot be established. The study describes associations only and cannot determine whether the identified factors are causes or consequences of poor feeding practices in children with severe acute malnutrition.

Abstract

Previous research has established determinants of young child feeding (IYCF) practices in the general child population, but determinants of these practices in children with severe acute malnutrition (SAM) are unknown. This study assessed the determinants of IYCF practices among children aged 6-23 months with SAM and under SAM treatment in a pastoralist and a predominantly agrarian setting in Ethiopia. As part of the baseline survey for the R-SWITCH cluster randomized control trial, we screened ~28,000 under-fives and included 486 children aged 6-23 months with SAM and under SAM treatment. Multivariable regression analysis was used to identify determinants on household, caregiver and child levels. Minimum meal frequency (MMF) was similar between children from the agrarian (53.9%) and pastoralist (51.9%) setting. The prevalence of children with minimum dietary diversity (MDD) was low overall but higher among pastoralist children (31.5%) than children from the agrarian setting (19.0%; p = 0.012). The consumption of egg/flesh foods was lower among pastoralist children (5.6%) than agrarian children (16.9%, p = 0.085). Caregiver literacy was positively associated with a higher likelihood of MMF (IRR = 1.21; 95% CI:1.02-1.43; p = 0.030), while caregiver depression was associated with a lower likelihood of MMF (RR = 0.97; 95% CI:0.95-0.99; p = 0.003). Improved water source (RR = 1.59; 95% CI:1.06-2.38; p = 0.037), caregiver literacy (RR = 2.04; 95% CI:1.25-3.34; p = 0.002), caregiver MDD (RR = 2.21; 95% CI:1.60-3.05; p ≤ 0.001), older children(RR = 1.05; 95% CI: 1.02-1.08;p ≤ 0.001), and pastoralist setting (RR = 1.62; 95% CI:1.07-2.44; p = 0.014) were associated with a significantly higher likelihood of meeting MDD. Conversely, caregiver depression (RR = 0.94; 95% CI:0.90-0.97; p < 0.001), caregiver mobility restriction (IRR = 0.94; 95% CI:0.89-1.00; p = 0.025), and food insecurity (RR = 0.64; 95% CI:0.41-1.01; p = 0.05) were associated with reduced MDD likelihood. Caregiver community involvement (IRR = 1.12; 95% CI:1.00-1.26; p = 0.038), caregiver MDD (RR = 1.67; 95% CI:1.10-2.53; p = 0.043), and older children (RR = 1.08; 95% CI:1.05-1.12; p < 0.001) were associated with increased egg/flesh-food consumption among children, while living in a pastoralist setting was associated with reduced it (RR = 0.36; 95% CI:0.13-0.97; p = 0.038). Integrated and Targeted interventions recommended: caregiver literacy/depression support to improve IYCF; livelihood-specific foods (eggs/flesh, fruits/vegetables); WaSH enhancements; community engagement; and IYCF counseling within CMAM programs.