INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
Factors Affecting Complementary Feeding Practices of Children 6-23  
Months in Developing Countries. A Review  
Mohamed Siraji Hassan1*, Phyllis Waruguru2  
1Student, Kabarak University, Kenya  
2Lecturer in Food, Nutrition, and Dietetics, Kabarak University, Kenya  
DOI: https://dx.doi.org/10.51244/IJRSI.2025.12110005  
Received: 10 November 2025; Accepted: 20 November 2025; Published: 27 November 2025  
ABSTRACT  
Good nutrition is important for healthy development of children, especially within the first two years of life. At  
6 months of age, children should be introduced to nutrition-adequate and safe complementary foods in addition  
to breastfeeding. Appropriate complementary feeding practices are important in reducing the incidence of  
malnutrition and improving the health and growth outcome of children. However, few children receive  
nutritionally adequate and safe complementary foods in many countries, with low indicators of complementary  
feeding practices. The objectives of the review were to systematically investigate, review and integrate findings  
from different studies so as to determine factors affecting complementary feeding practices of children aged 6-  
23 months in developing countries. A literature search on factors affecting complementary feeding practices in  
developing countries was undertaken in PubMed, Elsevier, and Google Scholar to identify relevant studies  
between 2014 and 2024. Twenty-five (25) studies were initially retrieved, with sixteen studies that met the study  
inclusion criteria chosen for data synthesis. Several factors were found to affect complementary feeding practices  
of children aged 6-23 months. These were; age of child, education level of mothers/caregivers, marital status of  
mother, occupation of mother, knowledge of caregiver, postnatal care, mothers’ decision-making role on use of  
family income, maternal beliefs, poverty/wealth status, household size, place of birth, accessibility to media and  
internet, support, and place of residence. Mothers with higher educational attainment were more likely to adopt  
appropriate feeding practices due to better access to information and decision-making skills. Similarly, families  
with greater financial resources could afford diverse and nutritious complementary foods, while access to  
postnatal care provided mothers with critical guidance on feeding practices. To improve complementary feeding  
practices, policies should focus on expanding maternal education initiatives, enhancing household economic  
empowerment, and integrating nutrition counseling into postnatal care services. Governments and health  
agencies need to invest in community-based programs and media campaigns that promote awareness and support  
for caregivers.  
Key words: Complementary feeding practices; children 6-23 months; developing nations; caregiver; postnatal  
care; and literature review  
INTRODUCTION  
Good nutrition is an important element in the healthy development of children, especially within the first two  
years of their life. Nutritional sufficiency during this period lowers morbidity and mortality, reduces the risk of  
chronic disease, leads to better cognitive development, enhanced educational achievement and high economic  
productivity in future (Molla et al., 2017). The World Health Organization (WHO) and the United Nations  
Children’s fund (UNICEF) recommends that infants be breast-fed exclusively for the first six months of life. At  
6 months of age, breast milk is no longer enough to meet the energy and nutrient requirements of infants, thus  
they should be introduced to nutrition-adequate and safe complementary foods from this period with continued  
breastfeeding until the age of 2 years and more (WHO, 2023).  
Complementary foods are any food or liquids, whether manufactured or locally prepared, suitable as a  
complement to breast milk or to a breast milk substitute, fed to infants during the complementary feeding period  
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(Umugwaneza et al., 2021). Complementary feeding practices with these foods are essential determinants of  
growth, health and development for infants and young children. The WHO has developed guidelines for  
appropriate complementary feeding. These are frequent, on-demand breastfeeding should continue until 2 years  
of age or beyond; responsive feeding should be practiced by feeding the child directly, slowly and patiently  
without using force; practice good hygiene and proper food handling; start at 6 months with small amounts of  
food and increase gradually as the child gets older; gradually increase food consistency and variety; increase the  
number of times that the is fed (2-3 meals per day for infants 6-8months of age and 3-4 meals per day for infants  
9-23 months of age, with 1-2 additional snacks as required); use fortified complementary foods or vitamin-  
mineral supplements as needed; and during illness, increase fluid intake including more breastfeeding, and offer  
soft, favorite foods (WHO, 2023a).  
Despite the importance of complementary feeding practices, few children receive nutritionally adequate and safe  
complementary foods; in many countries, less than a fourth of infants 6–23 months of age meet the criteria of  
dietary diversity and feeding frequency that are appropriate for their age (WHO, 2023). Poor complementary  
feeding of children 6-23 months is one of the contributing factors to malnutrition, which remains a major health  
problem globally. In 2022, about 149 million children under 5 years were stunted, 45 million were wasted and  
37 million were overweight or obese (WHO, 2023). Globally, the indicators of complementary feeding practices  
are low with the minimum meal frequency at 52.2%, minimum, dietary diversity at 29.4% and minimum  
acceptable diet at 16% (Feleke et al., 2022).  
In developing countries, the malnutrition situation is worse with very high levels of childhood underweight found  
in 12 African countries and 13 Asian countries including Sri Lanka (Kassa, et al., 2016). An analysis of  
Demographic and Health Surveys (DHS) data from twenty-one countries by Mekonen et al., (2024) revealed  
that sub optimal infant feeding practices and poor quality of complementary food contribute to nutrition  
deficiencies, impaired growth and deaths observed among children aged 6-23 months in developing countries.  
Feleke et al., 2022 add that complementary feeding practices are still poor in most developing countries and are  
even worsening in some of them.  
The promotion of appropriate complementary feeding practices has been viewed as an important approach to  
reducing the incidence of malnutrition and improve the health and growth outcome of children. The World  
Health Organization (WHO) has defined the following indicators for complementary feeding practices:  
introduction of various foods from the minimum dietary diversity (MDD); minimum meal frequency (MMF);  
minimum acceptable diet (MAD); and solid, semi-solid, or soft foods (Yunitasari et al., 2022). These indicators  
are crucial for assessing the complementary feeding practices of children 6-23 months.  
Several studies have identified factors that influence complementary feeding practices in general. These include  
socioeconomic status of caregivers, mother’s beliefs, knowledge of complementary feeding guidelines, influence  
of postnatal care and the social network, and lack of decision-making power in the household. Those factors can  
be classified at individual (child, caregiver, and child-caregiving) group (home/family, community, work  
environment) and society (food system, culture, economy) levels (Umugwaneza et al., 2021). Despite this, there  
is limited data on the specific factors that influence complementary feeding practices of children aged 6 to 23  
months in developing countries.  
Better knowledge and understanding of the factors influencing complementary feeding practices is crucial for  
creating targeted, caregiver-friendly and effective interventions that can help addressing the high prevalence of  
malnutrition and improve the health of children particularly in developing countries. Therefore, the purpose of  
this study was to review the literature and determine the factors that affect complementary feeding practices of  
children aged 6-23 months in developing countries.  
STUDY METHODOLOGY  
The study used systematic literature review (SLR), where a structured and methodological process to analyze  
existing research was conducted using online databases. Some of the online databases searched included  
PubMed, Elsevier as well as Google Scholar to identify relevant studies that are related to factors affecting  
complementary feeding practices in developing countries. The selection of SLR was based on the need to  
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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
understand the factors affecting complementary feeding practices among children aged 6-23 years. SLR also  
demands a clear process, which was used here, having a clear inclusion-exclusion criterion, and a transparent  
methodology to avoid researcher bias and enhance reproducibility (Hammarberg, Kirkman, & De Lacey, 2016).  
Further, SLR was used as it allows the researcher to identify trends or similar findings in relation to a certain  
topic, assess the validity and quality of evidence, as well as draw reliable and reproducible conclusions.  
Search key words  
The search terms included “children between 6-23 months complementary feeding practices”. “Factors affecting  
complementary feeding practices of children between 6-23 months”, “complementary feeding” ’Infants”.  
Relevant studies were selected based on a predefined inclusion and exclusion criteria and twenty-five studies  
were initially retrieved for data synthesis.  
Inclusion-exclusion criterion  
The inclusion and exclusion criteria were used. Studies included were those that talked about complementary  
feeding practices for children aged 6-23 months, that talked about various socioeconomic, and demographic and  
institutional factors. Studies included had to have clear quantitative or mixed methods approaches (both  
quantitative and qualitative methods), and that had considerable sample size. The studies included were those  
done in developing regions and countries, with studies picked from Sub-Saharan Africa (Benin, Nigeria, Malawi,  
Ethiopia, Tanzania, Uganda, and Kenya); South East Asia (India and Pakistan) among other developing  
countries. The studies picked had used various research designs/methods, including meta-analysis, cross-  
sectional and mixed methods. In relation to the period of research, the study picked studies done in the last ten  
years (with one exception, done in 2014), showing recent findings on children complementary feeding practices.  
Studies that were excluded included those done in more than ten years ago (before 2014), studies that did not  
focus on children complementary feeding, and those that were not done in developing regions and countries.  
Further, studies with no clear methodologies were excluded.  
Data synthesis and presentation  
Sixteen studies that met the study criteria were chosen for data synthesis. The publications were analyzed to  
determine factors affecting complementary feeding practices of children between 6-23 months. Information was  
synthesized based on the methodology used, and the findings. Similar findings were paired together (thematic  
analysis), with a support of some key studies that shared similar findings. Presentation of the results was in a  
matrix (see Table 1 on the summary of included studies).  
RESULTS OF THE ELIGIBLE LITERATURE REVIEW  
A total of 16 eligible articles were selected, extracted, and analyzed using content analysis. The studies are  
summarized in the table below.  
Table 1: Summary of included peer-reviewed studies  
References Title  
Study description  
Findings  
Feleke et al. Initiation  
of Study period 2020  
There was a statistically significant  
association of initiation of  
complementary feeding practices  
with mothers´ who were advised  
About CF during ANC follow up,  
children who were delivered at a  
health facility, mothers who use  
family planning methods and who  
give additional diet for the 1st six  
(2022)  
complementary feeding  
This study aimed at  
assessing the prevalence of  
Initiation of complementary  
feeding practice and its  
associated factors among  
mothers with children  
practice and associated  
factors among mothers  
having children 6-23  
months of age, in Meket  
Woreda, North Wollo  
Ethiopia,  
multicenter community-  
2020:  
a
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based  
study  
cross-sectional aged 6-23 months in Meket months of the child’s life and  
Woreda in 2020.  
breastfeeding  
makes  
the  
appearance of the mother thin, that  
The community  
based  
way  
they  
like  
to  
give  
quantitative cross-sectional  
study was conducted among  
416 mother-infant pairs of 6-  
23 months in Meket Woreda,  
Northwest Ethiopia from  
March 20-June 30, 2020.  
complementary foods to the  
infants(the attitude of the mothers  
towards complementary infant  
feeding) were factors that can  
increase  
appropriate  
complementary feeding practice.  
One stage cluster sampling  
technique was used to select  
study participants. A pre-  
A high frequency of antenatal visits  
(4+)  
was  
associated  
with  
appropriate complementary foods  
as compared to mothers who did  
not attend antenatal care, mothers  
who attend antenatal care have  
better access to health services such  
as nutrition counseling and respond  
to health information messages on  
CF.  
tested  
interviewer-based  
questionnaire was used to  
collect data.  
Khan et al., Determinant of Infant & Study period 2014  
Evidence suggests that maternal  
education [AOR (adjusted odds  
ratio)=1.79] is associated  
2017  
young child feeding  
practices by mothers in  
two rural districts of  
Sindh, Pakistan, a cross-  
sectional survey  
The aim of this study was to  
assess IYCF (Infant and  
young  
child  
feeding) with timely introduction of  
practices and its associated complementary feeding, meal  
factors in two rural districts  
frequency, dietary diversity, and  
the practice of a minimum  
of Pakistan.  
A cross-sectional study was  
conducted in two rural  
districts of Sindh province,  
Pakistan as part of a stunting  
prevention project between  
May and August 2014. A  
standard questionnaire on  
acceptable diet  
Moreover, household wealth status  
[AOR=9.7],  
maternal  
age  
[AOR=1.83], and the utilization of  
antenatal and postnatal visits  
[AOR=0.55] are associated with  
improved complementary feeding  
practices  
IYCF  
practices  
recommended by World  
Health Organization was  
used to collect information  
from 2013 mothers who had  
a child aged between 0 and  
23 months.  
A cross-sectional survey was  
conducted to collect data  
between May and August  
2014. The survey was  
designed to provide IYCF  
and baseline indicators on a  
representative  
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sample of households in the  
study area  
Rana et al., Descriptive study to Study period 2016,  
Education of mother, social  
customs like avoidance of  
colostrum affect the feeding  
among  
practices directly or indirectly.  
2016  
assess factors affecting  
core indicators of Infant  
and young child feeding  
practices in urban area of  
Gujarat state,India  
To assess factors affecting  
IYCF  
practices  
sampled population.  
Cross sectional study was  
conducted with sample  
comprising 300 mothers  
having children aged 0-23  
months.  
Umugwanez Factors  
influencing Study period 2021  
Caregivers’ knowledge and beliefs  
a et al., 2021 complementary feeding  
practices in rural and  
semi-urban Rwanda: a  
qualitative study  
about the benefits of breastfeeding  
It’s  
a
cross sectional  
&
timely  
introduction  
of  
descriptive qualitative study  
complementary food were found to  
be the primary individual factors  
facilitating good infant & young  
child feeding practices  
A total of ten Focus group  
discussions were conducted  
separately with mothers,  
fathers, grandmothers and  
community health workers  
from five different districts  
in Rwanda  
Community  
education & counselling programs  
were facilitators of good  
based  
nutrition  
complementary practices at the  
group level, At the society level,  
poverty  
in  
rural  
agrarian  
households was a barrier to optimal  
feeding practices  
Common belief of caregivers that  
infants should be given liquids as  
first foods, instead of semi solid  
foods was a barrier of good feeding  
practices.  
Varghese et Complementary feeding Study period 2022  
Appropriate  
complementary  
al., 2023  
practices in children  
aged 6–23 months in  
rural Lucknow: A cross-  
sectional study  
feeding was seen in slightly half of  
the children and it was found to be  
This study was done to  
describe the complementary  
feeding practices in children  
aged 6–23 months and to  
significantly  
associated  
with  
educational status of mothers.  
Children of mothers who were  
illiterate had around 59.0% lower  
odds of having appropriate  
complementary feeding [AOR  
0.412].  
identify  
the  
factors  
associated with appropriate  
feeding practices.  
A community based cross-  
sectional  
conducted in rural areas of  
study  
was  
There was a statistically significant  
Lucknow district in Uttar Association between initiation of  
Pradesh. A sample of 300 complementary feeding practices  
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mother-child pairs were and mothers who received  
selected  
by  
multistage counseling had better feeding  
random sampling technique. practices AOR 1.635.  
Data was collected using a  
Counseling on maternal dietary  
diversity had the strongest  
association with appropriate  
semi-structured  
questionnaire.  
feeding practices AOR 4.485.  
Oteri et al., Complementary Feeding Study period 2018  
Significant difference was noted  
2020  
Practices of Children 6-  
23 Months  
for  
complementary  
feeding  
A
cross-sectional  
association where Mother to  
Mother  
comparative study was  
Support  
Groups  
of Mother-To-Mother conducted in 3 locations in  
participants were 1.8 times more  
likely to introduce complementary  
foods at 6 months while MtMSGs  
non-participants introduced foods  
earlier than 6 months.  
Support  
Participants and  
Groups Kakuma division, Turkana  
County, Kenya.  
Non-Participants  
Kakuma,  
in The study targeted mothers  
Turkana of children 6 to 23 months of  
County, Kenya: A  
age. Systematic random  
sampling was used to select  
There was an association between  
the mother’s age and introduction  
Cross-Sectional  
Comparative Study  
the  
177  
MtMSGs  
of  
complementary  
feeding  
participants  
from  
15  
(p=0.015), breastfeeding status  
(p=0.027), and the duration of  
complementary feeding (p=0.031).  
MtMSGs groups, as the  
study group and 179  
MtMSGs non-participants  
from two locations which There was also a significant  
had no MTMSGs as the relationship between the mother’s  
comparison group. Data was education level and introduction of  
collected using a structured complementary feeding (p=0.003),  
questionnaire and Focused breastfeeding status (p=0.024), and  
Group Discussions (FGDs)  
the duration of complementary  
feeding (p=0.017),  
Marital status also affected the  
introduction of complementary  
foods  
(p=0.041), breastfeeding  
status (p=0.008) and duration of  
complementary feeding (p=0.021)  
Mitchodigni Complementary feeding Study period 2013  
et al., 2017. practices: determinants  
Factors such as socioeconomic  
aspects,  
farming  
practices,  
Poor complementary feeding  
of dietary diversity and  
meal frequency among  
children aged 6–23  
months in Southern  
Benin  
household demographics, cultural  
practices and geography. Child age  
(p=0.0294), income allocated to  
feeding (0.0083), commune of  
residence (p=0.0009), ethnicity  
(p=0.0214), caregivers’ occupation  
practices have detrimental  
effects on child growth,  
development and survival.  
This cross-sectional study in  
rural areas of southern Benin  
examined some determinants  
of complementary feeding  
(p=0.0326),  
marital  
status  
(p=0.0055) and household size  
using  
(p=0.0001) were identified as the  
practices  
socioeconomic and dietary  
data collected among 1225  
primary caregivers. Data was  
main  
factors  
affecting  
complementary feeding practices.  
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collected from October 2013  
to December 2013.  
Molla et al., Complementary Feeding Study period 2015  
Exposure to public media [AOR =  
2.50], occupation of mother [AOR  
= 9.50], mothers decision making  
role on how to use family income  
[AOR = 5.54], and use of postnatal  
care service [AOR = 5.98] were  
found to be independent predictors  
of complementary feeding practice  
2017  
Practice and Associated  
The aim of the study was to  
Factors among Mothers assess the prevalence of  
Having Children 6–23 complementary feeding  
Months of Age,  
practice and its associated  
factors among mothers with  
children aged 6−23 months  
Northeast  
in Lasta District, Northeast  
Lasta District, Amhara  
Region,  
Ethiopia  
Ethiopia,  
2015.  
A
community based cross-  
sectional study design was  
conducted  
among  
476  
mothers who had children  
aged 6–23 months in the  
study area. Simple random  
sampling technique was used  
to select the required sample.  
A face-to-face interview was  
done to collect data using  
structured questionnaire.  
Nkoka,  
Factors associated with Study period 2017  
Children born of mothers with  
Mhone & complementary feeding  
secondary  
or  
postsecondary  
This study aimed to examine  
factors associated with  
Ntends,  
2018.  
practices  
children aged 6–23  
among  
education [AOR = 2.46] and from  
mothers working in agriculture  
[AOR = 2.65] and living in the  
central region [AOR = 2.84] were  
significantly more likely to have  
timely introduction to solid, semi-  
solid or soft food. Being >1 y of age  
was associated with reduced odds  
of achieving minimum meal  
frequency [AOR = 0.67]. In  
addition, children >1 y of age from  
mothers older than 24 y [AOR =  
1.53] and from mothers with  
primary, secondary and post-  
secondary education [AOR = 1.65]  
were significantly more likely to  
achieve minimum dietary diversity.  
Children from rich households  
[AOR = 1.37] were more likely to  
achieve both minimum dietary  
diversity and minimum acceptable  
diet. Finally, exposure to mass  
complementary  
feeding  
months in Malawi: an  
practices among children  
the  
analysis  
of  
aged 6–23 months.  
Demographic and  
Utilizing data from the  
Health Survey 2015–  
2016  
2015–16  
Malawi  
Demographic and Health  
Survey (MDHS), 4732  
children aged 6–23 months  
and their mothers were  
analyzed. Multistage cluster  
sampling  
design  
that  
included sampling weights  
was used. The impact of  
child, maternal, household,  
community  
service utilization factors on  
complementary feeding  
practices was examined .  
and  
health  
media  
significantly  
increased odds of achieving  
minimum meal frequency,  
[AOR  
=
1.31]was  
associated with  
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minimum dietary diversity and  
minimum acceptable diet.  
Mekbib et Magnitude and Factors The aim of this study was to In this study only 10.75% children  
al., 2014  
Associated  
with assess the prevalence of aged 6-23 months received  
Appropriate  
appropriate complementary appropriate  
complementary  
Complementary Feeding feeding  
practices  
and feeding. Child’s age (AOR=4.21),  
among Mothers Having associated factors among education  
level  
of  
mother  
Children 6-23 Months- mothers having 6 - 23 (AOR=3.84), and postnatal care  
of-Age in Northern months of age children in follow up (AOR=2.80) were found  
Ethiopia; A Community- Northern Ethiopia. Methods- to be independent predictor of  
Based Cross-Sectional A community-based cross timely initiation of complementary  
Study.  
sectional study design was feeding.  
conducted among 428  
mothers who had children  
with 6-23 months of age in  
Northern Ethiopia.  
Simple random sampling  
was used to select the  
required number of sample  
size.  
A
face-to-face  
interview was used to collect  
data  
using  
structured  
questionnaire.  
Belete et al., Optimal complementary Study period 2021  
The overall proportion of mothers  
with optimal complementary  
(2022)  
feeding practices and  
This study was aimed as  
associated  
factors  
feeding practice was 18.1%.  
Mothers from Kebeles with no  
NGO support were less likely  
(AOR=0.54) to practice optimal  
complementary feeding compared  
to those from Kebeles that received  
support.  
assessing  
the  
optimal  
feeding  
among mothers having  
children 6 to 23 months,  
south WOLLO zone,  
Dessie ZURIA, Ethiopia  
complementary  
practices and associated  
factors among mothers  
having children aged 6-23  
months.  
A
community-based  
Mothers of children aged 20-23  
comparative cross-sectional  
study was conducted on a  
total of 732 randomly  
selected mothers having  
children 6 to 23 months of  
age from March 10 to April  
21, 2021. Data was collected  
months  
were  
four  
times  
(AOR=4.47) more likely to practice  
optimal complementary feeding  
than mothers having children 6-8  
months of age.  
using  
an  
interviewer-  
administered questionnaire.  
Sichalwe et Knowledge and practice Study period 2022  
Nearly half of the mothers  
introduced liquids and gave semi-  
solid food to their children at the  
recommended age of six months.  
al., 2023  
of  
complementary  
This  
mothers’  
feeding (CF) knowledge and  
practices for children aged  
6–24 months, highlighting  
links to adverse health  
study  
examines  
feeding among mothers  
in  
Tanzania: Communty-  
complementary  
Dar-es-Salaam,  
Associations  
between maternal education and  
knowledge of dietary  
diversification (p-value=0.01). The  
were  
observed  
based  
study.  
cross-sectional  
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outcomes and childhood study also found a connection  
malnutrition from both between CF-related information  
delayed and early CF and timely CF initiation  
(p-  
initiation  
months).  
(before  
six value=0.01).  
A community-based cross-  
sectional study collected data  
from 422 mothers through  
multistage sampling. A pre-  
tested  
structured  
questionnaire was used a  
Ali et al., Complementary feeding Study period 2019  
Multivariate regression analysis  
(2021)  
practices and associated  
factors among children  
aged 6–23 months in  
Pakistan.  
shows that child age  
(p-  
This study aims to identify  
value=0.01), child weight at birth  
(p-value=0.01), mother’s access to  
newspapers and magazines (p-  
value=0.09) at the individual level,  
wealth at the household level (p-  
value=0.02), and prenatal visits (p-  
value=0.00) at the community level  
are significant predictors of  
complementary feeding practices  
among children aged 6–23 months  
in Pakistan.  
the  
determinants  
of  
inadequate complementary  
feeding practices among  
children aged 6 to 23 months  
in Pakistan by using the  
latest  
nationally  
representative data from the  
Pakistan Demographic and  
Health Survey (2017–18).  
Mekonen et Complementary feeding Study period 2015-2020  
The prevalence of appropriate  
complementary feeding practices  
among mothers of children aged 6  
to 23  
al., 2024  
practices and associated  
factors among mothers  
of children aged 6 to 23  
months in Sub Saharan  
This study aimed to  
determine the prevalence and  
associated  
factors  
of  
appropriate complementary months in sub-Saharan African  
feeding practices among countries was 13.02% . Maternal  
mothers of children aged 6 to educational level [AOR=0.69],  
23 months in subSaharan marital status of the mother  
African countries:  
a
multilevel analysis of  
the recent demographic  
and health survey.  
African countries.  
[AOR=0.85], sex of household  
head [AOR=1.78], total children  
ever born [AOR=1.52], media  
exposure [AOR=0.74], ANC visits  
A multilevel mixed-effect  
analysis was carried out  
using recent demographic  
health survey data from 19  
attended  
during  
pregnancy  
[AOR=0.73], place  
sub-Saharan  
countries,  
African  
were of delivery [AOR=0.92], currently  
which  
conducted between 2015 and breastfeeding [AOR=1.12], PNC  
2020. A total weighted checkup [AOR=0.75], the current  
sample of 60,266 mothers of age of the child [AOR=0.26], birth  
children aged 6 to 23 months order [AOR=1.31], number of  
were included in the study. under 5 children in the household  
The demographic health [AOR=0.76], community illiteracy  
survey employs a stratified [AOR=1.09], and country category  
two-stage  
technique.  
sampling [AOR=1.62] were significantly  
associated with appropriate  
complementary feeding practices.  
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Yunitasari  
et al., 2022  
Factors  
with complementary  
feeding  
associated The study aim was to analyze The probability of achieving  
the factors associated with minimum dietary diversity (MDD)  
feeding was high in the  
practices complementary  
among children aged 6– practices among children  
23 months in Indonesia. aged 6–23 months in  
Indonesia.  
following: children aged 18–23  
months (OR=9.58), children of  
mothers with higher education  
A cross-sectional design was (OR=5.95),  
employed using data from households with upper wealth  
the 2017 Indonesia index (OR=2.53), children of  
Demographic and Health mothers who received childbirth  
Survey. A total of 502,800 assistance by professionals  
children  
from  
mothers with children aged (OR=1.63), and children of  
6–23 months were recruited mothers who had access to the  
through multistage cluster Internet (OR=1.26). Moreover,  
sampling.  
children from households with the  
upper wealth index (OR=1.40),  
children whose mothers were  
employed (OR=1.19) living in  
urban areas (OR=1.28) and  
predisposing,  
children of mothers who received  
Data were analyzed using a  
logistic regression test to  
determine the correlation  
between  
enabling, and reinforcing  
factors and complementary  
feeding practices  
childbirth  
professionals (OR=1.33) were  
more likely to meet  
assistance  
by  
Minimum Meal Frequency (MMF).  
Children aged 18–23 months  
(OR=2.40), of mothers with higher  
education  
(OR=3.15),  
from  
households with upper wealth  
index (OR=1.41) and born with  
professional childbirth assistance  
(OR=1.82) were significantly  
associated  
with  
minimum  
acceptable diet (MAD)  
Kassa, et al., Appropriate  
Study period 2015  
The practice of appropriate  
complementary feeding was  
minimal. Child’s age  
2016  
complementary feeding  
This study was aimed at  
practices and associated  
factors among mothers  
of children age 6–23  
months in Southern  
Ethiopia, 2015  
assessing  
practices  
of  
complementary feeding and (12–17 and 18–23 months) [AOR:  
associated factors among 2.75, 2.64], educational level of  
mothers of children aged 6– mother (primary and secondary and  
23 months.  
above schools) [AOR: 3.24, 3.21],  
and smaller family size [AOR:  
12.10] were found to be  
A community-based cross  
sectional study design was  
independent  
611  
appropriate  
predictors  
complementary  
of  
conducted  
among  
mothers who had children  
with 6–23 months of age in  
the ten randomly selected  
feeding practice of 6–23 months  
old children.  
Kebeles  
administrative unit).  
multistage sampling  
technique was used to  
(smallest  
A
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identify study subjects. Data  
were collected using pre-  
tested  
structured  
questionnaire.  
DISCUSSION OF RESULTS  
The results from the Table 1 above show some of the factors that affect feeding practices of children 6-23 months  
in Developing countries. A compiled and more detailed analysis are discussed below.  
Age of child  
The findings indicate that the age of the child is a factor that significantly influences feeding practices. A study  
by Belete et al., (2022) found out that mothers of children aged 20-23 months were four times more likely to  
practice optimal complementary feeding than mothers having children 6-8 months of age. Similar results were  
found in a study Mekonen et al., (2024) where children aged 6-11 months were less likely to have appropriate  
complementary feeding practices while another by Yunitasari et al., (2022) in Indonesia determined that children  
aged 18-23 months old had a high probability of achieving minimum dietary diversity and minimum acceptable  
diet. This might be attributed to vulnerable period for infants as they transition from exclusive breastfeeding to  
introduction of complementary feeding practices. Children are expected to learn to accept new foods and  
beverages which might be challenging. Additionally, mothers might belief that the infants cannot digest  
complementary foods and thus delay introducing them or reduce the number of feeding times. This however  
changes when the children become older.  
Education level of mothers/caregivers  
This study identified the education level of mothers as a significant factor influencing complementary feeding  
practices. Higher level of education was positively associated with appropriate complementary feeding practices.  
This finding was similar to that of a study by Rana et al., (2016), which showed that caregivers who have a low  
level of education may tend to pay less attention to nutrition education as the focus may be shifted towards  
obtaining daily bread for survival. Similar findings were obtained in studies by Oteri et al., (2020), Khan et al.,  
(2017) and Varghese et al., (2023) where children of mothers who were illiterate had lower odds of having  
appropriate complementary feeding. This could be because educated mothers are likely to access and read books  
and online materials with useful information about complementary feeding practices. This improves their ability  
to make decisions on their children’s nutritional needs. Moreover, mothers with higher education levels are  
highly likely to secure employment thus increasing their economic ability to access a diverse type of foods.  
Marital status of the mother  
Another factor affecting complementary feeding practices of children 6-23 months in developing countries is  
marital status of the mother. This study established that children whose mothers were married had appropriate  
feeding practices. The findings from a study by Mekonen et al., (2024) and another by Oteri et al., (2020) also  
established that married women have higher odds of appropriate complementary feeding practices. This might  
be due to an increased likelihood of economic, social and emotional support from the husband. The father may  
also be engaged in activities such as purchasing food and feeding children thus improving complementary  
feeding practices.  
Occupation of mother  
In this study complementary feeding practices was associated with the occupation of mothers. Similarly, a study  
conducted in Benin supports this finding that mothers’ occupation was significantly associated with  
complementary feeding practice. Mothers involved in income-generating activities were less likely to meet the  
minimum meal frequency. (Mitchodigni et al., 2017). A study carried out by Molla et al., (2017) also showed  
that the occupation of mothers was also a predictor affecting the feeding practices of children with housewives  
9.5 times more likely to practice appropriate complementary feeding in comparison to government employees.  
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This can be attributed to the time factor with housewives having more time to prepare meals and feed their  
children. It could also result from poor work conditions that makes complementary feeding challenging  
Knowledge of caregiver  
The knowledge of the mothers about breast feeding and complementary feeding is a factor that influences  
complementary feeding practices. Mothers who were aware of the advantages of breast feeding and  
complementary feeding such as better general health for the baby, better growth and cognitive development and  
family planning were highly likely to have appropriate feeding practices (Umugwaneza et al., 2021). A study  
carried out in Tanzania also established an association between knowledge of mothers and complementary  
feeding (Sichalwe et al., 2023). Mothers with knowledge on the importance of dietary diversity and meal  
frequency practiced better feeding practices compared to those with limited knowledge. This trend may be  
observed because with knowledge mothers are able to understand the benefits of complementary feeding, follow  
stated guidelines and take necessary steps to ensure that their children are well fed with the required diets.  
Postnatal care  
This study established that having postnatal care is associated with higher odds of appropriate complementary  
feeding. A study by Mekbib et al., (2014) also found out that postnatal care follow up was an independent  
predictor of complementary feeding practice. Ali et al., (2021), Nkoka et al., (2018), and Khan et al., (2017)  
studies also had similar results with children of mothers who had postnatal checkups more likely to meet  
minimum meal frequency, diet diversity and minimum acceptable diet requirements. The possible explanation  
for this is that during postnatal clinics, mothers’ knowledge is enhanced as they are taught how to take care of  
the children, the importance of nutrition, and best breast feeding and complementary feeding practices. Followup  
is also done to ensure that the children growth is consistent and within the normal ranges. Unfavorable beliefs  
and attitudes towards complementary feeding can also be addressed and changed during these visits.  
Mothers’ decision-making role on how to use family income  
The decision on how to use family income was also a contributing to complementary feeding practices. Mothers  
who made the decision on how the family income was used had better feeding practices compared to those who  
did not make the decision. Results from the Molla et al., (2017) study found out that women whose husbands  
were the only decision maker on family income were more likely to have inappropriate complementary feeding  
practice than the women who were involved in decision making about how to use family income. This might be  
because when mothers are in charge of making decisions about family income, they are more likely to purchase  
complementary food items for their children as they are more responsible for taking care of the feeding duties  
of the children than fathers.  
Maternal beliefs  
Complementary feeding practice is also affected by maternal beliefs. Beliefs such as breast milk production are  
insufficient, male children are often hungrier than female, and that children’s stomachs are not mature enough  
increased the likelihood of inappropriate feeding practices. The results from the study by Umugwaneza et al.,  
(2021), showed that the introduction of complementary foods at 4 or 5 months was sometimes practiced due to  
perceived insufficient production of breast milk. The study further established that complementary feeding  
initiation was also delayed or certain foods avoided over concerns about the physiological maturation of the  
stomach. Findings from the study by Sichalwe et al., (2023) also found that mothers believed that male children  
were unsatisfied with exclusive breast feeding and thus required more complementary foods than girls. These  
results might stem from the general believe that men require more energy to perform their duties compared to  
women thus need to be fed more food.  
Poverty/Wealth Status  
Findings from this study indicate that poverty level or wealth status affected complementary feeding practices.  
Children from households with low wealth status were more likely to experience poor complementary feeding  
practices compared to those with high wealth status. A study by Umugwaneza et al., (2021) showed financial  
constraints as an important barrier to complementary feeding with mothers unable to access and afford  
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complementary food practicing poor feeding practices. Similarly, a study by Yunitasari et al., (2022) showed  
that children belonging to families with higher wealth index had a higher probability of meeting the minimum  
meal diversity, minimum accepted diet and minimum meal frequency than those belonging to families with  
lower wealth index. This may be a result of mothers from high wealth index households being able to easily  
access and afford diverse complementary foods for their children.  
Household Size  
The size of the household is also another predictor’s variable showing association with complementary feeding  
practice. A study in Ethiopia established that those households’ having 1–3 persons were more likely to practice  
appropriate complementary feeding compared with those households’ having more than 4 members (Kassa et  
al., 2016). Mitchodigni et al., (2017) also found similar results with an increase in household size having a  
detrimental effect on children’s probability of minimum meal frequency. This can be explained by the fact that  
in large households, the share of food and frequency of meals is reduced to accommodate all the members. This  
is particularly problematic in poor households which lack the resources to acquire adequate foods.  
Place of birth  
The place of birth for the child was also associated with complementary feeding. The odds of appropriate  
complementary feeding practices were three times higher among children delivered in a health facility compared  
to those delivered at home. The study by Mekonen et al., (2024) indicated that mothers who delivered at home  
were 8% less likely to have appropriate complementary feeding practices compared with mothers who delivered  
at a health facility. Similar results were obtained from the study in Indonesia where mothers who had received  
child birth assistance by professionals were more likely to provide minimum dietary diversity, minimum  
acceptable diet, and minimum meal frequency to their children than those of mothers who were assisted by a  
non-professional. This is because mothers who deliver at health facilities are provided postnatal care information  
that includes complementary feeding guidelines for their children from the professional birth attendants  
Accessibility to media and Internet  
Another factor associated with complementary feeding practice of children 6-23 months is the accessibility to  
the media. Mothers who had access to media and internet practiced appropriate complementary feeding. This  
finding was in agreement with studies conducted in Indonesia (Yunitasari et al., 2022), in Pakistan (Khan et al.,  
2017) and in Ethiopia (Molla et al., 2017). Accessibility to media and Internet as a significant factor can be  
attributed to the fact that mothers are able to access complementary feeding and other nutrition information and  
enhance their knowledge on the nutritional requirements of their children and ensure optimal feeding.  
Support  
Support was also a factor in complementary feeding practice. Mothers who had support from the fathers and  
other mothers had an increased probability of good complementary feeding practices. A study by Belete et al.,  
(2022) in Ethiopia showed that mothers who got no support were 46% less likely to practice optimal  
complementary feeding than those who received support. Another study by Sichalwe et al., also found a link  
between the father’s involvement in the child feeding and appropriate complementary feeding practices. These  
results are consistent with those of Oteri et al., (2020) which noted significant difference in complementary  
feeding practices between mothers who had support and those who didn’t. Mothers who were a member of  
Mother-to-Mother support groups were 1.8 times more likely to have appropriate complementary feeding  
practices compared to those who were not members of the support group. The observed findings may be  
attributed to the fact that support acts as a motivating factor for mothers to work harder and be actively involved  
in their children health. It also helps boost the mothers’ confidence and helps to relieve the mother’s stress that  
may accrue from taking care of the children.  
Place of residence  
This study found out that living in either urban or rural areas affected complementary feeding of children 6-23  
months. Children who lived in urban areas were more likely to meet Minimum Meal Frequency (MMF)  
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(Yunitasari et al., 2022). However, on meeting the Minimum Diet Diversity (MDD), findings from the study by  
Mitchodigni et al., (2017) found out that children who lived in rural areas were better off compared to those in  
urban areas. This can be attributed to the fact that in rural areas there is a higher diversity of foods and that most  
households produce their own food. This is unlike urban areas where mothers can have difficulties accessing  
local dietary resources. On the other hand, those living in urban areas have a higher income status and are able  
to purchase more food leading to increased meal frequency.  
Study Limitations  
Despite providing useful insights into the factors affecting complementary feeding practices among children  
aged 6–23 months in developing countries, this review has several limitations, which include the following;  
Firstly, the review was based on secondary data drawn from published literature, which may not reflect the most  
recent changes in feeding practices or capture real-time contextual factors. Secondly, the selected studies vary  
widely in design, methodology, and geographic scope, making cross-comparison and synthesis somewhat  
challenging. Some studies used qualitative methods, while others used quantitative or mixed methods, which  
may have influenced how factors were identified and reported.  
Thirdly, publication bias cannot be ruled out, as studies with significant or positive findings are more likely to  
be published and included in databases like PubMed and Elsevier. The exclusion of grey literature may also have  
led to the omission of relevant findings.  
Additionally, while the review attempted to cover studies from developing countries, the data is  
disproportionately drawn from certain regions, particularly sub-Saharan Africa and South Asia, limiting the  
generalizability of findings to other developing contexts.  
Finally, the use of observational and cross-sectional studies in most of the reviewed articles limits the ability to  
infer causality between the identified factors and complementary feeding practices.  
Future research should aim to include longitudinal and intervention studies across a broader geographic range  
and integrate local cultural contexts to develop more targeted and sustainable strategies for improving  
complementary feeding practices.  
CONCLUSION  
Complementary feeding for children 6-23 months is important for their health and well-being. Proper  
complementary feeding practices are important for achieving the children’s nutritional requirements and  
preventing malnutrition. It is evident that from the analysis, that there are several factors that affect the  
complementary feeding practices of children 6-23 months in the developing countries. These factors include the  
age of child, education level of mothers/caregivers, marital status of the mother, occupation of mother,  
knowledge of caregiver, postnatal care, mothers’ decision-making role on how to use family income, maternal  
beliefs, wealth status, household size, place of birth, accessibility to media and internet, support, and place of  
residence.  
Thus, achieving appropriate complementary feeding practices requires several interventions involving various  
stakeholders. The identified factors should be put into consideration when developing strategies to deal with the  
challenges of poor complementary feeding practices. This will ensure children get adequate, safe and nutritious  
foods that will help prevent and eliminate diseases associated with poor nutrition, thus boosting their chances of  
survival.  
Complementary feeding for children aged 6–23 months is crucial for ensuring their optimal health and  
development. This review identified several factors influencing complementary feeding practices in developing  
countries. Among them, maternal education, household income, and postnatal care were the most significant  
predictors of appropriate complementary feeding. Educated mothers are more likely to access information and  
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implement best practices, while families with higher income can afford diverse and nutritious foods. Access to  
postnatal care ensures mothers receive essential guidance on feeding practices.  
RECOMMENDATIONS  
It is recommended that awareness creation strategies should be implemented to improve the knowledge of  
mothers of children 6-23 months on best complementary feeding practices. This can be through utilizing the  
mass media and during antenatal and postnatal clinics. Additionally, mothers unable to access and purchase  
complementary foods should be supported through employment opportunities and training on kitchen/home  
gardens. Targeted policies on enhancing complementary feeding practices should also be developed and  
integrated into health and child development agendas and guidelines.  
To improve complementary feeding, the following policy recommendations are suggested;  
Subsidize fortified complementary foods for low-income households through government-supported nutrition  
programs.  
Integrate targeted nutrition education into routine antenatal and postnatal care services, with an emphasis on  
maternal dietary diversity and appropriate meal frequency.  
Support maternal education and literacy programs to empower women with knowledge that promotes proper  
feeding practices.  
Expand social protection schemes that enhance household food security, such as cash transfers or food voucher  
systems.  
Promote community-based support groups, such as Mother-to-Mother Support Groups (MtMSGs), which have  
shown to positively influence feeding behaviors.  
Adopting these measures can help address the barriers to optimal complementary feeding, thereby reducing the  
burden of malnutrition and improving the survival and long-term well-being of children in developing countries.  
ACKNOWLEDGMENT  
The authors would like to acknowledge all the persons who participated in this study in one part or otherwise.  
First, the authors are grateful for the Kabarak University (in Kenya) for giving such opportunity to conduct this  
study. Second, the authors appreciate various authorships of the reviewed articles, which made this study  
successful.  
CONFLICT OF INTEREST  
The authors declare no conflict of interest at all.  
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