Factors influencing complementary feeding practices in Makueni County, Kenya: A Qualitative Study

Abstract Poor complementary feeding (CF) is a major contributor to undernutrition, child mortality, and poor health outcomes among children. However, little is known about the contextual factors influencing complementary feeding practices in Kenya, as qualitative evidence remains limited. A qualitative study was conducted to explore the factors influencing CF practices in rural Kenya. A total of five focus group discussions were conducted among primary caregivers of children aged 6-23 months (n=50) in Makueni County, Kenya. The discussions were recorded, transcribed verbatim, and thematically analyzed using NVivo 14 software. Most caregivers were aged 30 years and younger (66%), and 44% had achieved at least secondary-level education. Caregivers reported that they received information on CF mainly from the health care workers. The findings revealed that caregivers were the key decision makers in CF. Although the caregivers demonstrated knowledge of the timely initiation of complementary foods and dietary diversity, the knowledge did not translate into practice. The majority reported early initiation of CF due to the perception that breast milk production was inadequate. The commonly consumed complementary foods included starchy staples, thin tomato soups and animal milk. Protein-rich foods such as meats, eggs, nuts and seeds were rarely fed to the children. Fruit and vegetable consumption was limited due to seasonality and poor access. Our research established that several factors influence CF practices among the study population. These include nutrition knowledge and perceptions regarding CF; physical factors such as limited availability and seasonal access to diverse nutrient-rich foods; social factors including prevailing norms and food taboos; economic factors such as poverty, which reduced the ability to buy diverse food and food modification equipment such as blenders. These findings underscore the need for the government and development partners to design community-specific interventions that address not only knowledge gaps but also the socio-cultural, economic, and practical realities influencing feeding practices among children. Keywords: Caregivers, complementary feeding, focus groups, low-resource settings, rural, qualitative