Knowledge, attitudes and practices regarding complementary feeding among mothers and caregivers of children aged 6–23 months in Rwamagana District, Rwanda: a cross-sectional study using the 2021 WHO/UNICEF indicators
While caregivers in Rwamagana District, Rwanda, possess adequate knowledge about complementary feeding, a cross-sectional study reveals that actual practices—particularly regarding food consistency, egg consumption, and dietary diversity for infants aged 6–8 months—are suboptimal and driven more by caregiver education and confidence than by knowledge alone.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the first two years of life, a child's body is a construction site working at a frantic pace. To build bones, muscles, and a functioning brain, a growing child needs a steady supply of energy and specific nutrients like iron and zinc. For the first six months, breast milk provides everything a baby needs. But as the child grows, milk alone can no longer meet these rising demands. This is the moment when families must introduce other foods, a process known as complementary feeding. The challenge is not just to add food, but to add the right kind of food in the right amount. If a child receives only thin, watery porridge, they may fill their small stomach without getting enough nutrients. If they eat too many sugary snacks, they might fill up on empty calories, leaving no room for the nutrient-rich foods they need to grow. When these needs are not met, children can become stunted, meaning they stop growing as tall as they should, a condition that can permanently affect their health and development.
In Rwanda, public health workers have spent years teaching mothers when to start feeding their children solid foods. The general rule is simple: start at six months. But knowing the rule is different from following it perfectly every day. A recent study in the Rwamagana District sought to understand what is actually happening in the kitchens and bowls of families there. Researchers wanted to see if the knowledge mothers have translates into the food their children eat, and to find out which children are getting the best start and which are falling behind. They focused on children between six and twenty-three months old, a critical window where the right diet can prevent lifelong health problems.
The researchers visited two health centers in April 2024, interviewing ninety-two caregivers, mostly mothers, about what their children had eaten in the previous day. They used a set of modern guidelines from the World Health Organization and UNICEF to measure the quality of these diets. These guidelines look at whether a child eats enough different types of food, such as grains, beans, meat, eggs, and fruits, and whether they eat often enough to keep their energy up. The team also asked the caregivers what they believed about feeding, such as whether they thought thick porridge was better than watery porridge, and how confident they felt preparing meals.
The results painted a picture of a community that knows the rules but struggles with the details. Almost all the caregivers knew that they should start feeding their children solid foods at six months, and most understood that breastfeeding should continue for two years or longer. Their knowledge was high, yet this knowledge did not automatically lead to the best feeding practices. The study found that while older children, those between twelve and twenty-three months, were eating a wide variety of foods, the youngest infants, those between six and eight months, were faring much worse. Only about half of the youngest babies met the standard for a diverse diet, and nearly three out of ten of them had eaten no fruits or vegetables at all in the previous day.
A significant gap appeared in what the children were actually eating. While most children ate some form of fish or meat, eggs were rarely on the menu, with only about one in three children having eaten an egg in the last day. At the same time, unhealthy foods were common. About sixty percent of the children had eaten sweet foods like biscuits, cakes, or candy the day before the interview. This included half of the youngest infants, suggesting that sugary treats are entering their diets very early, potentially pushing out the more nutritious foods they need.
Perhaps the most surprising finding was that knowing the facts did not guarantee a good diet. The study showed no link between a caregiver's score on a knowledge test and the quality of food their child ate. A mother who knew all the right answers was not necessarily feeding her child better than one who knew fewer facts. Instead, the factors that mattered most were education and confidence. Children whose caregivers had a secondary school education or higher were much more likely to eat eggs and meat. Even more telling was the role of confidence: mothers who felt sure of their ability to prepare good food were far more likely to provide a diet that met all the necessary standards.
The researchers also noticed that many mothers felt it was difficult to provide a varied diet every day, often citing a lack of money or food availability as the reason. This suggests that the barrier is not a lack of information, but a lack of resources and practical skills. The study indicates that telling mothers "what" to feed is no longer enough. The next step for health programs is to help them with the "how." This means teaching them how to make thick, nutrient-dense porridge using affordable local ingredients like eggs and small fish, and helping them build the confidence to put these foods on the table. The goal is to move beyond simple advice and provide the practical support needed to turn good intentions into healthy meals for the youngest and most vulnerable children.
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