Dietary Knowledge, Complementary Feeding Practices and Nutrition Status of Children 6–23 Months Old in Siaya County, Kenya

Malnutrition remains a critical public health challenge in Kenya, particularly among children aged 6–23 months during the complementary feeding period. Siaya County reports stunting rates (19.2%) exceeding the national average (18.2%), with Alego Usonga Sub-County contributing 42% of the total county malnutrition cases, indicating urgent need for evidence-based interventions. The aim of the study was to assess dietary knowledge, complementary feeding practices, and nutritional status among children aged 6-23 months in Siaya County, Kenya. Three specific objectives target caregiver knowledge assessment, practice determination, and nutritional status evaluation with associated predictors. An explanatory sequential mixed-methods design was employed, collecting cross-sectional data from 282 caregiver-child pairs through semi-structured questionnaires and focus group discussions. Anthropometric measurements were analyzed using ENA for SMART (2015) software and compared against WHO growth standards. Statistical analysis was conducted using SPSS Version 26, with chi-square tests examining associations and logistic regression identifying predictors at p<0.05 significance level. The study found that while 70.2% of caregivers initiated complementary foods at the recommended age (6-8 months), significant practice gaps persisted: only 36.5% achieved minimum dietary diversity (MDD), 5.0 % met minimum meal frequency (MMF), and 4.6% achieved minimum acceptable diet (MAD). Malnutrition prevalence included stunting (29.08%), underweight (13.1%), and wasting (4.96%). Girls experienced significantly higher stunting rates than boys (36.55% vs 21.17%, p<0.05). Maternal education level showed significant association with MDD achievement (p=0.03), while male sex significantly increased odds of wasting (OR=13.4, p=0.013) and stunting (OR=2.15, p=0.005). Early solid food introduction at 4-6 months substantially increased stunting risk (OR=2.42-4.66, p<0.05). Despite adequate knowledge of feeding timing, caregivers demonstrated poor implementation of dietary diversity and meal frequency practices. Interventions on complementary feeding need to prioritize maternal education, address gender-specific feeding vulnerabilities, and strengthen community-based nutrition programs.

Complementary feeding; Malnutrition; Dietary diversity

1. 1-Kenya-Strategy-for-Maternal-Infant-and-Young-Child-Nutrition-2023-28. (n.d.). [Google Scholar] [Crossref]

2. Abeshu, M. A., Lelisa, A., & Geleta, B. (n.d.). Complementary feeding practices and stunting in Ethiopian children: The role of indigenous foods. Maternal & Child Nutrition, 18(2), 13312. [Google Scholar] [Crossref]

3. Achieving equity in health outcomes : highlights of important national and international papers. (2018). Manatū Hauora Ministry of Health. [Google Scholar] [Crossref]

4. And, W., & Health Transition Review, K. (1991). Malnutrition and gender relations in Western Kenya * (Vol. 1, Issue 2). [Google Scholar] [Crossref]

5. Anyati, C., Okello, D. M., Mainimo, E. N., & Okello-Uma, I. (2025). Nutritional knowledge, attitude, and practices among caregivers and nutritional status of children 6–24 months: evidence from Amuria and Soroti districts of Uganda. Discover Food, 5(1). https://doi.org/10.1007/s44187-025-00369-8 [Google Scholar] [Crossref]

6. Baby Friendly Community Initiative Implementation Guidelines. (2016). [Google Scholar] [Crossref]

7. Birhanu, F., Yitbarek, K., Bobo, F. T., Atlantis, E., & Woldie, M. (2024). Undernutrition in children under five associated with wealth-related inequality in 24 low- and middle-income countries from 2017 to 2022. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-53280-0 [Google Scholar] [Crossref]

8. Bolarinwa, O. A., Ahinkorah, B. O., Arthur-Holmes, F., Aboagye, R. G., Ameyaw, E. K., Budu, E., Seidu, A. A., Ighodalo, U. L., & Yaya, S. (2022). Sex inequality in early initiation of breastfeeding in 24 sub-Saharan African countries: A multi-country analysis of Demographic and Health Surveys. PLoS ONE, 17(5 May). https://doi.org/10.1371/journal.pone.0267703 [Google Scholar] [Crossref]

9. Cheruiyot, D. K. (2024). Socio-economic and Demographic Characteristics of Caregivers as a Determinant of Nutritional Status of Children Aged 6-59 Months in Kericho County, Kenya. Asian Journal of Medicine and Health, 22(12), 116–133. https://doi.org/10.9734/ajmah/2024/v22i121143 [Google Scholar] [Crossref]

10. Choudhury, S., Headey, D. D., & Masters, W. A. (2019). First foods: Diet quality among infants aged 6-23 months in 42 countries. https://doi.org/10.1016/j.foodpol.2019.101762 [Google Scholar] [Crossref]

11. Emon, M. M. H. (2024). Research Approach: A Comparative Analysis of Quantitative and Qualitative Methodologies in Social Science Research. https://doi.org/10.20944/preprints202412.1128.v1 [Google Scholar] [Crossref]

12. Global Nutrition Report 2022 Stronger commitments for greater action. (n.d.). [Google Scholar] [Crossref]

13. Guest, G., Bunce, A., & Johnson, L. (2006). How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822X05279903 [Google Scholar] [Crossref]

14. Improving Young Children’s Diets During the Complementary Feeding Period – UNICEF Programming Guidance, 2020 | UNICEF. (n.d.). Retrieved May 13, 2023, from https://www.unicef.org/documents/improving-young-childrens-diets-during-complementary-feeding-period-unicef-programming [Google Scholar] [Crossref]

15. Khamis, A. G., Mwanri, A. W., Ntwenya, J. E., & Kreppel, K. (2019). The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatrics, 19(1). https://doi.org/10.1186/s12887-019-1897-5 [Google Scholar] [Crossref]

16. Kimani-Murage, E. W., Kimiywe, J., Mutoro, A. N., Wilunda, C., Wekesah, F. M., Muriuki, P., Mwangi, B. M., Samburu, B. M., Madise, N. J., McGarvey, S. T., & Griffiths, P. L. (2021). Effectiveness of the baby-friendly community initiative on exclusive breastfeeding in Kenya. Maternal and Child Nutrition, 17(3). https://doi.org/10.1111/mcn.13142 [Google Scholar] [Crossref]

17. National Bureau of Statistics Nairobi, K. (2023). Kenya Demographic and Health Survey 2022 Key Indicators Report. www.DHSprogram.com. [Google Scholar] [Crossref]

18. Reynolds, E. C., Onyango, Di., Mwando, R., Oele, E., Misore, T., Agaya, J., Otieno, P., Tippett Barr, B. A., Lee, G. O., & Akelo, V. (2021). Mothers’ Perspectives of Complementary Feeding Practices in an Urban Informal Settlement in Kisumu County, Western Kenya. Current Developments in Nutrition, 5(5). https://doi.org/10.1093/cdn/nzab065 [Google Scholar] [Crossref]

19. Sahiledengle, B., Mwanri, L., Blumenberg, C., & Agho, K. E. (2023). Gender-specific disaggregated analysis of childhood undernutrition in Ethiopia: evidence from 2000–2016 nationwide survey. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16907-x [Google Scholar] [Crossref]

20. Semahegn, A., Tesfaye, G., & Bogale, A. (2014). Complementary feeding practice of mothers and associated factors in Hiwot Fana specialized hospital, eastern Ethiopia. Pan African Medical Journal, 18. https://doi.org/10.11604/pamj.2014.18.143.3496 [Google Scholar] [Crossref]

21. Silva, P., Araújo, R., Lopes, F., & Ray, S. (2023). Nutrition and Food Literacy: Framing the Challenges to Health Communication. In Nutrients (Vol. 15, Issue 22). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/nu15224708 [Google Scholar] [Crossref]

22. Stein, A., Molero, H., Hess, D., Luquette, M., & Pitt, M. B. (2020). Tension pneumothorax with evolving cysts in an infant. Pediatrics in Review, 41(11), E42–E45. https://doi.org/10.1542/pir.2018-0062 [Google Scholar] [Crossref]

23. Sunder Raj, R., & Ahmad Sheikh, S. (2024). Impact of Gender and Socioeconomic Factors on Nutrition and Health in Urban Slums of Raichur Karnataka India. International Journal of Science and Research (IJSR), 13(10), 1235–1242. https://doi.org/10.21275/SR241016231642 [Google Scholar] [Crossref]

24. Tebeje, T. M., Abebe, M., Tesfaye, S. H., Seboka, B. T., Argaw, G. S., Seifu, B. L., Mare, K. U., & Aragaw, F. M. (2024). Minimum meal frequency and associated factors among children aged 6–23 months in Sub-Saharan Africa: a multilevel analysis of the demographic and health survey data. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1468701 [Google Scholar] [Crossref]

25. Thurstans, S., Opondo, C., Seal, A., Wells, J. C., Khara, T., Dolan, C., Briend, A., Myatt, M., Garenne, M., Mertens, A., Sear, R., & Kerac, M. (2022). Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. In Nutrients (Vol. 14, Issue 5). MDPI. https://doi.org/10.3390/nu14050948 [Google Scholar] [Crossref]

26. UNICEF Kenya Annual Report 2024 ONLINE FILE.pdf. (n.d.). [Google Scholar] [Crossref]

27. UNICEF/WHO/World Bank group, J. C. malnutrition E. 2023. (2023). levels of malnutrition. Levels and Trends in Child Malnutrition of Malnutrition. [Google Scholar] [Crossref]

28. Victora, C. G., Christian, P., Vidaletti, L. P., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. The Lancet, 397(10282), 1388–1399. https://doi.org/10.1016/S0140-6736(21)00394-9 [Google Scholar] [Crossref]

29. Wanjohi, M. N., Pradeilles, R., Asiki, G., Holdsworth, M., Kimani-Murage, E. W., Muthuri, S. K., Irache, A., Laar, A., Zotor, F., Tandoh, A., Klomegah, S., Graham, F., Osei-Kwasi, H. A., Green, M. A., Coleman, N., Mensah, K., Akparibo, R., Aryeteey, R., Rousham, E. K., … Griffiths, P. (2023). Community perceptions on the factors in the social food environment that influence dietary behaviour in cities of Kenya and Ghana: A Photovoice study. Public Health Nutrition, 26(3), 661–673. https://doi.org/10.1017/S1368980022002270 [Google Scholar] [Crossref]

30. World Health Organization. (2021). Indicators for assessing infant and young child feeding practices: definitions and measurement methods. Geneva: Licence: CC BY- NC-SA 3.0 IGO; https://creativecommons.org/licenses/. 6. https://www.who.int/publications/i/item/9789240018389 [Google Scholar] [Crossref]

• Measuring Waste of Patient Time in Health Care at Non-Digitized Hospital: An Observational Study in Bangabandhu Sheikh Mujib Medical University, Bangladesh
• Reaffirming Clinical Confidence in Atorvastatin Therapy: A Digital Outreach Case Study from Tamil Nadu, India
• Clinical Manifestations and Therapeutic Response in a Patient with Hypothyroidism: A Case Report
• Eranda (Ricinus Communis) In Gridhrasi (Sciatica): Classical Rationale, Pharmacology and Clinical Evidence- A Narrative Literature Review
• Magnetotherapy in Pain Management: Mechanisms, Clinical Applications, and Future Perspectives – A Review