# Determinants of Inadequate Complementary Feeding Among Children Aged Six Months to Two Years: A Cross-Sectional Study in Children's Hospital, Lahore

## TL;DR

This study explores why infants in Lahore receive poor complementary feeding, finding that factors like paternal education and antenatal care influence feeding practices.

## Contribution

The study identifies paternal education and antenatal care as key factors influencing complementary feeding practices in an urban Pakistani hospital setting.

## Key findings

- Only 56.5% of children had timely initiation of complementary feeding.
- Paternal education significantly influenced meal frequency in infants.
- Dietary diversity and MAD rates were below regional standards.

## Abstract

Background

Inadequate complementary feeding, including delayed, insufficient, or inappropriate introduction of complementary foods, remains a major contributor to infant malnutrition in low- and middle-income countries. In Pakistan, key indicators such as dietary diversity and minimum acceptable diet (MAD) remain below regional standards despite widespread breastfeeding. This study aimed to identify the factors associated with inadequate complementary feeding among infants attending an urban tertiary hospital.

Methodology

A cross-sectional study was conducted at the Pediatric Medical Department of The Children’s Hospital, Lahore, over a two-month period. A structured questionnaire was administered to 62 mothers of children aged six to 24 months. Variables assessed included parental education, healthcare utilization, income, cultural practices, and feeding behaviors. Associations between these characteristics and WHO-recommended indicators of timing of complementary feeding initiation, 24-hour dietary diversity (a child meets the Minimum Dietary Diversity if, in the past 24 hours, they consumed at least five of the following eight WHO food groups: breast milk; grains, roots, and tubers; legumes and nuts; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables), 24-hour meal frequency, and MAD were evaluated using chi-square tests with a significance threshold of p < 0.05.

Results

Among 62 children included in the study, timely initiation of complementary feeding occurred in 35 (56.5%), while 29 (46.8%) achieved minimum dietary diversity, 24 (38.7%) met age-appropriate meal frequency, and 20 (32.3%) achieved MAD. Maternal education (p = 0.082) and place of delivery (p = 0.113) showed borderline associations with timely initiation. Father’s education was significantly associated with meal frequency (p = 0.031), while antenatal care visits demonstrated a borderline association (p = 0.053). For MAD, father’s education (p = 0.056) and antenatal visits (p = 0.094) showed borderline effects.

Conclusions

The study demonstrates low dietary diversity and inadequate meal frequency among infants, with paternal education and antenatal care utilization emerging as important influencing factors. Strengthening nutrition counseling during ANC and PNC visits, improving parental education, and addressing cultural barriers may enhance complementary feeding practices and help reduce early childhood malnutrition in Pakistan.