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Effect of Complementary Feeding Education on Appropriate Complementary Feeding Practices among Mothers of Infants in Nigeria

Abstract

Complementary feeding is an important component of infant nutrition and involves introducing appropriate foods alongside continued breastfeeding when an infant is developmentally ready. Appropriate complementary feeding supports adequate growth, development, immunity, and prevention of undernutrition during the period when infants' nutritional requirements increase beyond what breast milk alone can provide. However, mothers in Nigeria may experience challenges in practicing appropriate complementary feeding because of limited knowledge, cultural beliefs, misconceptions about infant nutrition, household food insecurity, economic constraints, maternal workload, limited access to skilled nutrition counselling, and conflicting information from informal sources. Complementary feeding education provides an opportunity to improve mothers' understanding and practical application of appropriate feeding practices, including timing of introduction, food consistency, meal frequency, dietary diversity, responsive feeding, food hygiene, and safe preparation and storage. Against this background, this study investigates the effect of complementary feeding education on appropriate complementary feeding practices among mothers of infants in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Social Ecological Model. The Health Belief Model explains how mothers' perceptions of the benefits of appropriate complementary feeding, perceived barriers, perceived susceptibility of infants to nutrition-related problems, self-efficacy, and cues to action may influence feeding practices. Social Cognitive Theory emphasizes observational learning, behavioural modelling, self-efficacy, reinforcement, and environmental influences in the development of complementary feeding behaviours. The Social Ecological Model highlights the influence of mothers, families, communities, healthcare providers, cultural practices, socioeconomic conditions, food availability, and health systems on infant feeding. Collectively, these theoretical perspectives provide a suitable framework for explaining how complementary feeding education may influence appropriate complementary feeding practices among mothers of infants in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise mothers of infants aged 6–12 months residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, and eligible mothers. Complementary feeding education will be assessed using indicators such as exposure to education sessions, frequency and duration of education, knowledge of the appropriate timing for introducing complementary foods, food consistency and texture, meal frequency, dietary diversity, age-appropriate portion sizes, responsive feeding, continued breastfeeding, food preparation methods, food hygiene, hand hygiene, safe water use, safe storage of prepared foods, feeding during illness, appropriate use of locally available foods, identification of nutrient-rich foods, avoidance of inappropriate foods, and recognition of reliable infant nutrition information. Appropriate complementary feeding practices will be assessed using indicators such as timely introduction of complementary foods, appropriate meal frequency, minimum dietary diversity, suitable food consistency, age-appropriate portion sizes, continued breastfeeding, responsive feeding, hygienic food preparation, safe food storage, handwashing before food preparation and feeding, use of safe drinking water, appropriate feeding during illness and recovery, and avoidance of nutritionally inappropriate or potentially unsafe foods. Data will be collected using structured questionnaires, complementary feeding practice assessment tools, 24-hour dietary recall, food-preparation observation checklists where appropriate, infant feeding records, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize mothers' demographic and socioeconomic characteristics, infant characteristics, sources of nutrition information, food availability, and complementary feeding practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of complementary feeding education on appropriate complementary feeding practices. Where a quasi-experimental design is adopted, complementary feeding practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that complementary feeding education has a significant positive effect on appropriate complementary feeding practices among mothers of infants in Nigeria. Mothers exposed to structured, evidence-based, practical, and culturally appropriate complementary feeding education are expected to demonstrate improved feeding practices compared with mothers without comparable exposure. Education may improve mothers' understanding of the appropriate timing for introducing complementary foods, dietary diversity, meal frequency, food consistency, portion sizes, responsive feeding, and continued breastfeeding. Practical education may also improve mothers' ability to prepare nutritious meals using affordable and locally available foods while maintaining appropriate food and hand hygiene. It may help mothers identify and avoid inappropriate feeding practices, respond appropriately to infants' changing nutritional needs, and seek professional nutrition advice when feeding difficulties arise. However, household food insecurity, poverty, high food prices, cultural beliefs, maternal workload, family influence, limited access to nutritious foods, and inadequate healthcare or nutrition support may reduce the effectiveness of education alone. The study therefore expects accessible, practical, culturally sensitive, and sustained complementary feeding education, supported by appropriate maternal and child health and nutrition services, to contribute significantly to improved complementary feeding practices among mothers of infants in Nigeria. The study is expected to contribute to the literature on complementary feeding, infant nutrition, breastfeeding, maternal and child health, nutrition education, food safety, child growth and development, dietary diversity, responsive feeding, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, nutrition programmes, nurses, midwives, dietitians, community health workers, development partners, and policymakers regarding strategies for improving infant nutrition. The study will also provide evidence-based recommendations for integrating complementary feeding education into routine maternal and child health services, strengthening practical nutrition counselling, promoting locally available nutrient-rich foods, improving food and water hygiene education, addressing socioeconomic and cultural barriers to appropriate feeding, strengthening community-based nutrition programmes, and developing sustainable interventions that promote healthy complementary feeding practices among mothers of infants across Nigeria.

Keywords: Complementary feeding education, appropriate complementary feeding practices, mothers of infants, infant nutrition, breastfeeding, dietary diversity, responsive feeding, maternal and child health, nutrition education, food safety, Nigeria, public health.