Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis

Abstract

Background: To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality.

Methods: From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed.

Results: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD.

Conclusion: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers.

Keywords: Dietary diversity; Ethiopia.; Meal frequency; Minimum acceptable diet; Systematic review.

Fig. 1

A PRISMA flow chart illustrating the study selection process included for systematic review and meta-analysis Minimum acceptable diet among 6 to 23 months in Ethiopia

Fig. 2

forest plot for meta-analysis of minimum acceptable diet among children in 6 to 23 months in Ethiopia

Fig. 3

Forest plot for meta-analysis of minimum acceptable diet among children in 6 to 23 months in subgroup analysis with residence

Fig. 4

Galbraith graph for MAD heterogeneity

Fig. 5

Sensitivity analysis for MAD heterogeneity with fixed effect model

Fig. 6

Sensitivity analysis for MAD heterogeneity with random effect model

Fig. 7

The overall pooled odds ratio of the association between maternal education (being primary) and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 8

The overall pooled odds ratio of the association between maternal education (being secondary and above) and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 9

The overall pooled odds ratio of the association between age of child (12-17 months) and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 10

The overall pooled odds ratio of the association between age of child (18-23 months) and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 11

The overall pooled odds ratio of the association between having nutrition information and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 12

The overall pooled odds ratio of the association between having media exposure and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 13

The overall pooled odds ratio of the association between maternal knowledge and the MAD among children aged 6 to 23 months in Ethiopia

Fig. 14

Funnel Plot to Assess Publication Bias for MAD

Fig. 15

Trim and fill for small study effect of MAD