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. 2015 Sep 13;11(Suppl 1):1–13. doi: 10.1111/mcn.12196

Comparisons of complementary feeding indicators among children aged 6–23 months in Anglophone and Francophone West African countries

Abukari I Issaka 1,✉, Kingsley E Agho 2, Andrew N Page 2, Penelope L Burns 1, Garry J Stevens 1, Michael J Dibley 3
PMCID: PMC6860182  PMID: 26364788

Abstract

Stunting, a consequence of suboptimal complementary feeding practices, continues to be a significant public health problem in West Africa. This paper aimed to compare rates of complementary feeding indicators among children aged 6–23 months between four Anglophone and seven Francophone West African countries. The data used for this study were the most recent Demographic and Health Surveys of the various countries, namely Ghana, Liberia, Nigeria, Sierra Leone (Anglophone countries), Benin, Burkina Faso, Cote d'Ivoire, Guinea, Mali, Niger and Senegal (Francophone countries) conducted between 2006 and 2013. The analyses were limited to last‐born children aged 6–23 months and covered 34 999 children: 12 623 in the Anglophone countries and 22 376 children in the Francophone countries. Complementary feeding indicators were examined using the method proposed by the World Health Organization (WHO) in 2008. Introduction of solid, semi‐solid or soft foods among children aged 6–23 months in the Anglophone countries ranged from 55.3% (Liberia) to 72.6% (Ghana). The corresponding rates for the Francophone countries ranged from 29.7% (Mali) to 65.9% (Senegal). The average rate of minimum dietary diversity for the Anglophone countries was 32.0% while that of the Francophone countries was only 10.6%. While the minimum meal frequency rates ranged between 42.0% (Sierra Leone) and 55.3% (Nigeria) for the Anglophone countries, the corresponding rates for the Francophone countries ranged between 25.1% (Mali) and 52.4% (Niger). Both the Anglophone and the Francophone countries reported alarmingly low rates of minimum acceptable diet, with the two groups of countries averaging rates of 19.9% (Anglophone) and 5.5% (Francophone). The rates of all four complementary feeding indicators across all the 11 countries fell short of the WHO's requirement for optimal complementary feeding practices. Intervention studies using cluster‐randomised controlled trials are needed in order to improve the nutritional status of young children in West Africa.

Keywords: complementary feeding, dietary diversity, meal frequency, acceptable diet, child nutrition, West Africa

Introduction

The achievement and maintenance of healthy growth and survival of young children in their early years requires appropriate complementary feeding practices. According to a past study (Jones et al. 2003), 6% of under‐five deaths could be prevented through the achievement of universal coverage with improved complementary feeding alone. More than 41% of these under‐five deaths occur in Sub‐Saharan Africa (Spencer 2004). About 35% of child deaths and 11% of the global burden of disease are attributed to nutrition‐related factors (Sadras & Rodriguez 2007). According to a United Nations report (Communication 2009), 40% of children under 5 years of age in Africa are stunted, which may be as a result of inappropriate complementary feeding practices.

Because of the importance of appropriate complementary feeding to optimal growth and development of the young child, the WHO (World Health Organization 2003) recommended that exclusive breastfeeding should be practised for the first 6 months of life, and thereafter, nutritionally adequate and safe complementary foods be given to the child alongside breastfeeding up to 2 years or beyond.

According to a WHO report (WHO 2000), complementary feeding practices in West African countries are still suboptimal, contributing to child growth retardation and undernutrition, morbidity and mortality in these countries. The rates of stunting among children under 5 years of age ranged from 28% in Ghana to 36.4% in Sierra Leone in the Anglophone countries and from 19.6% in Senegal to 54.8% in Niger in the Francophone countries (Kothari et al. 2010). These results suggest that complementary feeding among children in these countries is still suboptimal, which is reflected in the high levels of stunting in these countries (Kothari et al. 2010).

Among the 11 countries, some may lag behind in their effort towards improving complementary feeding practices and consequently towards improving child nutrition. Those countries could potentially learn from other countries that may have lower rates of undernutrition (Dorais 2003). The unique characteristics of each country need to be considered in order to develop locally acceptable interventions to improve complementary feeding practices and can be informed by these cross‐country comparisons.

The comparisons may also be of benefit to regional development assistance partner organisations for the purpose of resource allocation and programme evaluation (Dibley et al. 2010). The present paper aimed to compare the four complementary feeding indicators among children aged 6–23 months in four Anglophone and seven Francophone West African countries.

Key messages

  • The Anglophone countries had a higher proportion of all four complementary feeding indicators compared with the Francophone countries.

  • The complementary feeding indicators in all the countries improved with increased child's age.

  • Minimum dietary diversity, minimum meal frequency and minimum acceptable rates were very low in all the countries.

  • Governments and stakeholders should target mothers whose methods of feeding children do not contribute to the improvement of complementary feeding practices in West Africa.

  • In order to improve dietary diversity among children, mothers should be encouraged to do way with cultural beliefs that prohibit young children from eating certain selected nutritious foods.

Ethical consideration

This study was based on an analysis of existing public domain survey datasets that is freely available online with all identifier information removed. The first author communicated with MEASURE DHS/ICF International and permission was granted to download and use the data for his doctoral dissertation with the School of Medicine at the University of Western Sydney, Australia.

Methods

Sources of data

This study utilised the most recent Demographic and Health Survey (DHS) data of Ghana 2008 (Ghana Statistical Service and Ghana Health Service 2009), Liberia 2007 (Ministry of Health and Social Welfare et al. 2008), Nigeria 2013 (National Population Commission 2009), Sierra Leone 2008 (Statistics Sierra Leone and Ministry of Health and Sanitation 2009), Benin 2012 (Ministère du Développement et al. 2013), Burkina Faso 2010 (Institut National de la Statistique et de la Démographie (INSD) et al. 2012), Cote d'Ivoire 2012 (Ministère de la Santé et de la Lutte contre le Sida (MSLS) et al. 2013), Guinea 2012 (Institut National de la Statistique et al. 2013), Mali 2006 (Cellule de Planification et de Statistique (CPS) et al. 2008), Niger 2012 (Institut National de la Statistique (INS) et al. 2013) and Senegal 2011 (Ministère de la Santé et de la Prévention Médicale Centre de Recherche pour le Développement Humain (CRDH) 2012).

Survey designs

The DHS of the various countries provides details of the methodology, sampling procedures and the questionnaires. A multistage cluster sampling design was used in all surveys. Furthermore, all surveys interviewed ever‐married women in the reproductive age group (15–49 years) from the selected households. The analyses were limited to last‐born children aged 6–23 months living with the respondent (women aged 15–49 years), alive, and the total weighted sample size was 34 999 children: 12 623 in the Anglophone countries and 22 376 children in the Francophone countries. The number of children selected from the various countries and the proportion of children representing the different age groups are represented in Tables 1 and 2. The surveys yielded high response rates in the various countries. These rates ranged from 94% in Sierra Leone to 97% in Ghana and Nigeria for the Anglophone countries and from 94% in Senegal to 97% in Guinea for the Francophone countries. All the surveys used similar data collection methods (standardised questionnaires).

Table 1.

Population of children represented and proportion of children in the different age groups: Anglophone countries

Age group

Ghana (n = 822)

(%)

Liberia (n = 1458)

(%)

Nigeria (n = 8786)

(%)

Sierra Leone (n = 1557)

(%)
6–11 36.0 39.2 36.4 38.5
12–17 37.0 28.9 37.6 39.4
18–23 27.0 31.9 26.0 22.1
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Table 2.

Population of children represented and proportion of children in the different age groups: Francophone countries

Age group

Benin (n = 3732)

(%)

Burkina Faso (n = 4204)

(%)

Cote d'Ivoire (n = 2109)

(%)

Guinea (n = 1944)

(%)

Mali (n = 3798)

(%)

Niger (n = 3451)

(%)

Senegal (n = 3137)

(%)
6–11 34.9 34.9 36.2 36.0 34.2 37.1 33.9
12–17 32.4 34.5 33.1 38.7 40.2 38.6 38.5
18–23 32.7 30.6 30.7 25.3 25.6 24.3 27.6
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Complementary feeding indicators

The new and updated Infant and Young Child Feeding indicators recommended by the WHO (Daelmans et al. 2009), which were based on a mother's recall of foods given to her child in the 24 h preceding the survey, were used in the analyses for all four countries. These indicators are (WHO 2010):

  • Introduction of solid, semi‐solid or soft foods; defined as the proportion of infants aged 6–8 months who received solid, semi‐solid or soft foods.

  • Minimum dietary diversity; defined as the proportion of children aged 6–23 months who received foods from at least four food groups. The food groups used for tabulation of this indicator are: (1) grains, roots and tubers; (2) legumes and nuts; (3) dairy products (milk, yogurt, cheese); (4) flesh foods (meat, fish, poultry and liver/organ meats); (5) eggs; (6) vitamin A‐rich fruits and vegetables; and (7) other fruits and vegetables.

  • Minimum meal frequency; defined as the proportion of breastfed and non‐breastfed children aged 6–23 months who received solid, semi‐solid or soft foods or milk feeds the minimum number of times or more (two times for breastfed infants aged 6–8 months, three times for breastfed children aged 9–23 months, and four times for non‐breastfed children aged 6–23 months).

  • Minimum acceptable diet; defined as the proportion of children aged 6–23 months who received a minimum acceptable diet (apart from breast milk). This is a composite indicator which is calculated from the two fractions that follow: breastfed children aged 6–23 months who received at least the minimum dietary diversity and minimum meal frequency during the previous day and non‐breastfed children aged 6–23 months who received at least two milk feeds and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day.

The age bracket (6–23 months) was further disaggregated into 6–11, 12–17 and 18–23 months.

Statistical analysis

Analyses were performed using the Stata statistical software package version 12.0 (Stata Corp., College Station, TX, USA) with ‘Svy’ commands to allow for adjustments for the cluster sampling design. The Taylor series linearisation method was used in the surveys to estimate 95% confidence intervals around prevalence estimates of the four complementary indicators.

An alternative to the method used in this analysis is the multi‐level modelling approach. The survey method adopted in this study compares closely with the multi‐level modelling approach in terms of the effects of primary interest. This highlights the robustness of the results obtained in this paper.

Results

The respective complementary feeding indicators among children of the four age groups (6–11, 12–17, 18–23 and 6–23 months) for the Anglophone and Francophone countries included in this study are illustrated in Figs 1, 2, 3, 4, 5. The horizontal bars in the columns of figures represent rates with 95% confidence interval. The rates of introduction of solid, semi‐solid or soft foods among the Anglophone children aged 6–8 months were: 72.6% {95% confidence interval (CI): [64.6, 79.3]} (Ghana); 68.8% {95% CI: [66.0, 71.6]} (Nigeria); 64.7% {95% CI: [58.5, 70.4]} (Sierra Leone); and 55.3% {95% CI: [47.4, 63.0]} (Liberia). The corresponding rates for the Francophone children were: 65.9% {95% CI: [60.7, 70.8]} (Senegal); 61.1% {95% CI: [54.0, 67.8]} (Cote d'Ivoire); 47.4% {95% CI: [41.6, 53.2]} (Guinea); 46.6% {95% CI: [42.9, 50.5]} (Burkina Faso); and 29.7% {95% CI: [25.7, 34.0]} (Mali) (Fig. 1).

Figure 1.

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Introduction of solid, semi‐solid or soft foods among children aged 6–8 months. Horizontal bars represent rates with 95% confidence intervals. Years of survey: Ghana – 2008, Liberia – 2007, Nigeria – 2008, Sierra Leone – 2008, Benin – 2012, Burkina Faso – 2010, Cote d'Ivoire – 2012, Guinea – 2012, Mali – 2006, Niger – 2012, Senegal – 2011.

Figure 2.

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Minimum dietary diversity, meal frequency and acceptable diet among children aged 6–11 months. *Data for Mali were not enough to plot. The horizontal bars in the columns represent rates with 95% confidence interval. Years of survey: Ghana – 2008, Liberia – 2007, Nigeria – 2008, Sierra Leone – 2008, Benin – 2012, Burkina Faso – 2010, Cote d'Ivoire – 2012, Guinea – 2012, Mali – 2006, Niger – 2012, Senegal – 2011.

Figure 3.

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Minimum dietary diversity, meal frequency and acceptable diet among children aged 12–17 months. The horizontal bars in the columns represent rates with 95% confidence interval. Years of survey: Ghana – 2008, Liberia – 2007, Nigeria – 2008, Sierra Leone – 2008, Benin – 2012, Burkina Faso – 2010, Cote d'Ivoire – 2012, Guinea – 2012, Mali – 2006, Niger – 2012, Senegal –2011.

Figure 4.

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Minimum dietary diversity, meal frequency and acceptable diet among children aged 18–23 months. The horizontal bars in the columns represent rates with 95% confidence interval. Years of survey: Ghana – 2008, Liberia – 2007, Nigeria – 2008, Sierra Leone – 2008, Benin – 2012, Burkina Faso – 2010, Cote d'Ivoire – 2012, Guinea – 2012, Mali – 2006, Niger – 2012, Senegal – 2011.

Figure 5.

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Minimum dietary diversity, meal frequency and acceptable diet among children aged 6–23 months. The horizontal bars in the columns represent rates with 95% confidence interval. Years of survey: Ghana – 2008, Liberia – 2007, Nigeria – 2008, Sierra Leone – 2008, Benin – 2012, Burkina Faso – 2010, Cote d'Ivoire – 2012, Guinea – 2012, Mali – 2006, Niger – 2012, Senegal – 2011.

The rates of minimum dietary diversity among the Anglophone children aged 6–11 months were: 30.3% {95% CI: [24.5, 36.8]} (Ghana); 21.5% {95% CI: [17.7, 25.8]} (Sierra Leone); 20.7% {95% CI: [18.8, 22.6]} (Nigeria); and 12.8% {95% CI: [9.8, 16.5]} (Liberia). The corresponding rates among the Francophone children were: 14.7% {95% CI: [12.8, 16.7]} (Benin); 11.5% {95% CI: [8.8, 14.7]} (Senegal); 5.5% {95% CI: [3.7, 7.9]} (Guinea); 4.4% {95% CI: [2.9, 6.6]} (Cote d'Ivoire); 4.3% {95% CI: [3.2, 5.7]} (Niger); 2.7% {95% CI: [1.8, 4.0]} (Mali); and 2.0% {95% CI: [1.32, 2.92]} (Burkina Faso). Among the Anglophone children aged 12–17 months, the rates of minimum dietary diversity were: 61.6% {95% CI: [54.9, 67.8]} (Ghana); 40.7% {95% CI: [35.1, 46.5]} (Sierra Leone); 32.1% {95% CI: [29.8, 34.4]} (Nigeria); and 24.6% {95% CI: [19.1, 31.1]} (Liberia). The corresponding rates among the Francophone children were: 28.5% {95% CI: [25.7, 31.4]} (Benin); 20.3% {95% CI: [17.0, 24.0]} (Senegal); 13.2% {95% CI: [10.3, 16.9]} (Guinea); 9.6% {95% CI: [7.9, 11.6]} (Niger); 8.3% {95% CI: [5.8, 11.6]} (Cote d'Ivoire); 5.4% {95% CI: [4.1, 7.0]} (Mali); and 5.2% {95% CI: [4.0, 7.0]} (Burkina Faso). The rates of minimum dietary diversity among the Anglophone children aged 18–23 months were: 56.6% {95% CI: [46.8, 65.8]} (Ghana); 55.2% {95% CI: [44.9, 65.1]} (Sierra Leone); 36.8% {95% CI: [32.7, 41.0]} (Nigeria); and 24.6% {95% CI: [18.0, 32.6]} (Liberia). The corresponding rates among the Francophone children were: 28.9% {95% CI: [25.7, 32.3]} (Benin); 19.7% {95% CI: [15.0, 25.5]} (Guinea); 19.4% {95% CI: [15.0, 24.8]} (Senegal); 11.3% {95% CI: [8.4, 15.1]} (Niger); 9.1% {95% CI: [5.7, 14.2]} (Cote d'Ivoire); 8.0% {95% CI: [5.1, 12.5]} (Mali); and 5.8% {95% CI: [4.4, 7.6]} (Burkina Faso). Among the Anglophone children aged 6–23 months, the rates of minimum dietary diversity were: 47.7% {95% CI: [43.4, 52.0]} (Ghana); 34.3% {95% CI: [30.3, 38.5]} (Sierra Leone); 27.4% {95% CI: [25.8, 29.0]} (Nigeria); and 18.9% {95% CI: [15.6, 22.9]} (Liberia). The corresponding rates for the Francophone children were: 22.8% {95% CI: [21.1, 25.6]} (Benin); 16.7% {95% CI: [14.3, 19.4]} (Senegal); 11.6% {95% CI: [9.8, 13.7]} (Guinea); 7.6% {95% CI: [6.4, 9.0]} (Niger); 6.7% {95% CI: [5.3, 8.3]} (Cote d'Ivoire); 4.8% {95% CI: [3.8, 6.2]} (Mali); and 4.2% {95% CI: [3.5, 5.0]} (Burkina Faso).

The rates of minimum meal frequency among the Anglophone children aged 6–11 months were: 54.6% {95% CI: [52.3, 56.9]} (Nigeria); 49.5% {95% CI: [43.1, 55.9]} (Ghana); 47.5% {95% CI: [42.0, 53.0]} (Sierra Leone); and 46.5% {95% CI: [40.5, 52.6]} (Liberia). The corresponding rates for the Francophone children were: 47.0% {95% CI: [43.5, 50.6]} (Niger); 43.4% {95% CI: [40.6, 46.2]} (Benin); 36.1% {95% CI: [31.7, 40.7]} (Cote d'Ivoire); 29.8% {95% CI: [26.2, 33.8] (Senegal); and 29.8% {95% CI: [26.2, 33.8]} (Burkina Faso and Guinea). Among the Anglophone children aged 12–17 months, the rates of minimum meal frequency were: 54.1% {95% CI: [51.7, 56.6]} (Nigeria); 51.4% {95% CI: [44.7, 58.2]} (Liberia); 50.1% {95% CI: [44.1, 56.1]} (Ghana); and 37.2% {95% CI: [32.1, 42.6]} (Sierra Leone). The corresponding rates among the Francophone children were: 54.9% {95% CI: [51.2, 58.6]} (Niger); 53.5% {95% CI: [50.6, 56.4]} (Benin); 42.7% {95% CI: [37.8, 47.8]} (Cote d'Ivoire); 38.5% {95% CI: [35.3, 41.8]} (Burkina Faso); 28.2% {95% CI: [24.4, 32.4]} (Guinea); and 28.0% {95% CI: [16.1, 44.1]} (Mali). The rates of minimum meal frequency among the Anglophone children aged 18–23 months were: 61.1% {95% CI: [57.2, 64.9]} (Nigeria); 58.9% {95% CI: [50.1, 67.2]} (Liberia); 53.1% {95% CI: [43.6, 62.3]} (Ghana); and 38.7% {95% CI: [31.3, 46.6]} (Sierra Leone). The corresponding rates for the Francophone children were: 59.8% {95% CI: [54.1, 65.3]} (Niger); 58.0% {95% CI: [49.7, 65.9]} (Cote d'Ivoire); 54.8% {95% CI: [51.0, 58.5]} (Benin); 44.4% {95% CI: [41.0, 47.9]} (Burkina Faso); 36.9% {95% CI: [30.6, 43.7]} (Guinea); 33.5% {95% CI: [28.2, 39.3]} (Senegal); and 25.9% {95% CI: [20.2, 32.6]} (Mali). The rates of minimum meal frequency among the Anglophone children aged 6–23 months were: 55.3% {95% CI: [53.5, 57.0]} (Nigeria); 50.7% {95% CI: [45.9, 55.4]} (Liberia); 50.4% {95% CI: [46.0, 54.7]} (Ghana); and 42.0% {95% CI: [38.3, 45.8]} (Sierra Leone). The corresponding rates for the Francophone children were: 52.4% {95% CI: [49.7, 55.0]} (Niger); 49.6 {95% CI: [47.5, 51.6]} (Benin); 42.4% {95% CI: [38.8, 46.1]} (Cote d'Ivoire); 36.6% {95% CI: [34.6, 38.6]} (Burkina Faso); 31.6% {95% CI: [28.8, 34.6]} (Senegal); 30.3% {95% CI: [27.3, 33.5]} (Guinea); and 25.1% {95% CI: [23.0, 27.4]} (Mali).

Among the Anglophone children aged 6–11 months, the rates of minimum acceptable diet were: 20.6% {95% CI: [15.6, 26.6]} (Ghana); 14.7% {95% CI: [13.1, 16.3]} (Nigeria); 14.4% {95% CI: [11.2, 18.3]} (Sierra Leone); and 8.2% {95% CI: [5.8, 11.5]} (Liberia). The corresponding rates for the Francophone children were: 8.2% {95% CI: [6.8, 9.8]} (Benin); 5.3% {95% CI: [3.6, 7.6]} (Senegal); 2.8% {95% CI: [1.7, 4.6]} (Cote d'Ivoire); 2.8% {95% CI: [2.0, 3.9]} (Niger); 1.9% {95% CI: [1.0, 3.6]} (Guinea); 1.7% {95% CI: [1.0, 3.0]} (Mali); and 1.2% {95% CI: [0.8, 1.9]} (Burkina Faso). The rates of minimum acceptable diet among the Anglophone children aged 12–17 months were: 38.5% {95% CI: [32.5, 44.9]} (Ghana); 21.1% {95% CI: [19.1, 23.2]} (Nigeria); 20.6% {95% CI: [16.3, 25.7]} (Sierra Leone); and 14.6% {95% CI: [10.5, 19.9]} (Liberia). The corresponding rates for the Francophone countries were: 16.8% {95% CI: [14.7, 19.0]} (Benin); 8.3% {95% CI: [6.2, 11.0]} (Senegal); 6.6% {95% CI: [5.3, 8.3]} (Niger); 5.8% {95% CI: [3.9, 8.6]} (Cote d'Ivoire); 3.1% {95% CI: [2.2, 4.4]} (Burkina Faso); 2.9% {95% CI: [1.7, 4.8]} (Guinea); and 3.0% {95% CI: [2.0, 4.5]} (Mali). Among the Anglophone children aged 18–23 months, the rates of minimum acceptable diet were: 31.9% {95% CI: [24.4, 40.5]} (Ghana); 26.9% {95% CI: [23.4, 30.8]} (Nigeria); 25.1% {95% CI: [18.7, 32.8]} (Sierra Leone); and 17.2% {95% CI: [12.2, 23.8]} (Liberia). The corresponding rates for the Francophone children were: 17.3% {95% CI: [14.8, 20.2]} (Benin); 8.1% {95% CI: [5.0, 12.8]} (Guinea); 7.0% {95% CI: [4.8, 10.3]} (Niger); 6.8% {95% CI: [4.7, 10.0]} (Senegal); 6.7% {95% CI: [3.8, 11.7]} (Cote d'Ivoire); 4.2% {95% CI: [1.9, 9.0]} (Mali); and 4.1% {95% CI: [3.0, 5.7]} (Burkina Faso). The rates of minimum acceptable diet among the Anglophone children aged 6–23 months were: 29.9% {95% CI: [26.1, 34.1]} (Ghana); 18.9% {95% CI: [17.5, 20.3]} (Nigeria); 18.5% {95% CI: [15.6, 21.8]} (Sierra Leone); and 12.1% {95% CI: [9.7, 15.1]} (Liberia). The corresponding rates for the Francophone children were: 13.3% {95% CI: [12.1, 14.6]} (Benin); 6.8% {95% CI: [5.3, 8.8]} (Senegal); 5.1% {95% CI: [4.2, 6.1]} (Niger); 4.6% {95% CI: [3.6, 5.9]} (Cote d'Ivoire); 3.6% {95% CI: [2.6, 5.0]} (Guinea); 2.7% {95% CI: [2.2, 3.3]} (Burkina Faso); and 2.7% {95% CI: [1.8, 4.0]} (Mali).

Discussion

In this study, prevalence of the four complementary feeding indicators among children of four age groups in both Anglophone and Francophone West African countries was assessed. Prevalence estimates varied according to complementary feeding indicator, country and age group. The study showed a consistent pattern. Prevalence of all four complementary feeding indicators among children aged 6–23 months was higher in the Anglophone countries compared with their Francophone counterparts, although this prevalence fell short of the rates recommended by WHO/UNICEF in order to improve complementary feeding practices and reduce child morbidity and mortality in the West African sub‐region.

On average, among the Anglophone countries, Ghana had the highest prevalence of the complementary feeding indicators while Liberia had the lowest. Among the Francophone countries, Benin had the highest prevalence of the complementary indicators while Burkina Faso and Mali had the lowest.

Introduction of solid foods to a baby after 6 months has proven benefits (Symon & Bammann 2012). The present analysis revealed that the rates of introduction of solid, semi‐solid or soft foods were higher in the Anglophone countries compared with the Francophone countries. Previous studies have outlined factors that posed risks to the introduction of solid, semi‐solid or soft foods among children aged 6–11 months. Some of the factors that were found to be negatively associated with this complementary feeding indicator were illiterate mothers and mothers who had no schooling (Kabir et al. 2012; Ng et al. 2012). Other factors found to be negatively associated with introduction of solid, semi‐solid or soft foods were mothers who had no antenatal clinic visits (Ng et al. 2012; Patel et al. 2012) and mothers who did not have access to newspapers/magazines (Patel et al. 2012). In order to improve complementary feeding practice, stakeholders and governments of countries with low rates of introduction of solid, semi‐solid or soft foods should make greater efforts to target these factors.

Past studies (Hatløy et al. 2000; Arimond & Ruel 2004; Kalanda et al. 2006; Schiess et al. 2010) have indicated that dietary diversity is an important component of infant and young child feeding, as it is associated with overall dietary quality, micronutrient intake of young children, household food security and better nutritional status of children in developing countries. The present study revealed that the rates of minimum dietary diversity across all three age groups in both the Anglophone and Francophone countries were very low. The rates were alarmingly low among children of the youngest age group (6–11 months) in all the countries. The rates were relatively better among the Anglophone countries. It is no surprise, therefore, that the Francophone countries recorded high rates of stunting (Kothari et al. 2010). The existence of cultural beliefs that prohibit young children from eating certain selected nutritious foods (Paul et al. 2011) may be a contributing factor to the low rates of minimum dietary diversity in these countries. The low rates of minimum dietary diversity may also be due to lack of resources. Household capacity to purchase necessary foods is a prerequisite to the achievement of dietary diversification for children. Food donors such as the World Food Program should consider providing not only staple foods such as grain, but also eggs, milk, meat and vegetables to needy countries.

Most mothers and caregivers may be aware of the role dietary diversity plays in the health of a child; however, the lack of resources acts as a barrier to those mothers or caregivers in their effort to put knowledge into practice (Kikafunda et al. 2003). Past studies have found factors negatively associated with appropriate dietary diversity to include poor households (Patel et al. 2012; Ng et al. 2012; Senarath et al. 2012), limited access to the media (radio, newspaper/magazine) (Patel et al. 2012), mothers with no schooling (Patel et al. 2012; Senarath et al. 2012) and younger children (Kabir et al. 2012; Victor et al. 2012). Targeting these factors when implementing interventions could improve dietary diversity practices in these countries.

This study revealed that the rates of minimum meal frequency among all three age groups in both the Anglophone and Francophone countries were quite low, especially among the children of the youngest group (6–11 months). The same pattern of rates was exhibited by the two groups of countries. According to a past study (Jones et al. 2003), feeding patterns such as the timing and number of meals or snacks require close attention. One factor that can influence minimum meal frequency is the behaviour of the mother or caregiver, including the level of encouragement provided to the child during feeding, the frequency with which the food is given and the environment in which the feeding takes place (Lutter 2003; Dewey & Brown 2003). Mothers or caregivers should be encouraged to feed children regularly in a supportive environment, especially younger children aged 6–11 months who have only recently been introduced to complementary foods.

Proportions of acceptable diet among children of all three age groups in all 11 countries were very low. This is not surprising because minimum acceptable diet is a composite indicator that incorporates minimum dietary diversity and minimum meal frequency. Thus, the low minimum dietary diversity and meal frequency recorded by both groups of countries resulted in the low rates of minimum acceptable diet in those countries.

An important strength of this study is that the survey was nationally representative and used standardised methods to achieve high response rates. The high response rates meant that the findings in the study would be devoid of sampling bias in the countries studied.

The main limitation of this study is that the surveys for our analysis were conducted in different years (2007–2008 for the Anglophone countries and 2006–2012 for the Francophone countries) and the infant and young child feeding practices could have changed in some countries as a result of education programmes or other reasons. These findings should be carefully interpreted with consideration to the adequacy and quality of feeds given to infants, although the timeliness is satisfactory in many countries. A timely complementary feeding rate based on a 24‐h dietary recall does not really reflect the timing of the introduction of complementary food as this could include those who had started complementary feeding even before the sixth month.

In conclusion, the rate of complementary feeding indicators in West Africa is still way below the 90% (optimal complementary feeding) level recommended by WHO/UNICEF in order to reduce child morbidity and mortality in the sub‐region. All the countries, especially the Francophone ones, should strive to improve complementary feeding practices especially among young children aged 6–11 months. Mothers should be encouraged to introduce solid, semi‐solid or soft foods to their infants aged 6–8 months. Dietary diversity should be encouraged with appropriate modification of traditional feeding practices that prohibit children from eating nutritionally rich foods such as eggs, meat and fish in order to improve upon dietary diversity practices. Education of mothers and caregivers on appropriate feeding techniques is crucial to improve the number of children meeting the requirements for minimum acceptable diet in the countries studied.

Source of funding

None.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Contributions

A.I.I. designed the study, performed the analysis and prepared the manuscript; K.E.A. provided advice on the study design and data analysis. P.L.B., A.N.P., G.J.S. and M.J.D. provided revision of the final manuscript. All authors read and approved the manuscript.

Acknowledgement

The authors thank ICF Macro for making the DHS data available.

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