MINIMUM MEAL FREQUENCY AND ASSOCIATED FACTORS AMONG CHILDREN AGED 6-23 MONTHS ATTENDING HEALTH CENTERS IN HARAR CITY, HARARI REGION, EASTERN ETHIOPIA

Abstract

Background: - Adequate nutrition during the first two years of life is vital for brain and physical development, preventing malnutrition, and ensuring long-term health. Proper nutrition enhances cognitive function, reduces chronic disease risk, and fosters healthy eating habits. Key feeding practices include breastfeeding, timely introduction of complementary foods, and regular meal frequency. Currently, there is limited data on Minimum Meal Frequency (MMF) and its associated factors among children attending health facilities in the Harari region of Eastern Ethiopia. Objective: - To assess the magnitude of minimum meal frequency and associated factors among children aged 6 to 23 months attending health centers in Harar City, Eastern Ethiopia. Methods: - A facility-based cross-sectional study was conducted in five health centers in Harar City, with 516 mothers/caregivers of children aged 6 to 23 months selected through a systematic random sampling technique. MMF was assessed using a minimum frequency depending on child age; two for 6-8 months and three for 9-23months. Data were collected using a structured questionnaire via Kobo Toolbox. Both bivariable and multivariable logistic regression analyses were performed to identify factors associated with feeding frequency. Results were reported using adjusted odds ratios with a 95% confidence interval. Result: - A total of 514 mothers/caregivers participated (99.6% response rate). Overall, 61.5% (95% CI: 57%–65%) of children met the Minimum Meal Frequency (MMF). In multivariable analysis, younger age (6–8 months) was associated with higher odds of MMF (AOR = 1.85; 95% CI: 1.10–3.12), and breastfeeding substantially increased the likelihood of meeting MMF (AOR = 3.20; 95% CI: 1.80–5.68). Maternal primary education (AOR = 2.40; 95% CI: 1.05 5.45) and high maternal knowledge (AOR = 3.40; 95% CI: 1.40–8.10) were also significant predictors. Household socioeconomic status showed a graded association: middle-class (AOR = 3.80; 95% CI: 1.40–10.1), rich (AOR = 2.50; 95% CI: 1.02–6.10), and very rich households (AOR = 3.20; 95% CI: 1.20–8.50) had higher odds of meeting MMF. Children from food secure households were more likely to achieve MMF (AOR = 3.10; 95% CI: 1.40–6.70), and postnatal care attendance further increased MMF likelihood (AOR = 3.10; 95% CI: 1.70–5.50). Among Health Belief Model constructs, high perceived susceptibility (AOR = 1.45; 95% CI: 1.05–2.20) and high self-efficacy (AOR = 2.05; 95% CI: 1.30–3.25) were also significantly associated with MMF. The final model demonstrated good fit (Hosmer–Lemeshow p = 0.177) with no evidence of multicollinearity. Conclusion: This study highlights that more than one-thirds of children did not fulfill MMF and it is associated with socioeconomic, maternal such as education status and maternal knowledge on MMF, and psychosocial factor significantly influence adherence to MMF among children in Harar, Ethiopia. Addressing economic and educational gaps through targeted interventions is crucial for improving child feeding practices. Multisectoral approaches are needed to enhance nutrition outcomes and healthcare equity.