Abstract / Summary
Abstract Background: Poor complementary feeding is a major cause of child undernutrition. Rwanda has reduced stunting, but district-level evidence on caregivers’ knowledge, attitudes and practices, measured with the 2021 World Health Organization (WHO) and UNICEF indicators, is limited. Objectives: To describe knowledge, attitudes and practices regarding complementary feeding among mothers and caregivers of children aged 6–23 months in Rwamagana District, and to explore factors associated with feeding practices. Methods: A cross-sectional study was conducted at Gishari and Rwamagana health centres in April 2024. Ninety-two caregivers were interviewed with a structured questionnaire that included a 24-hour dietary recall. WHO/UNICEF indicators were calculated for 84 children aged 6–23 months. Data were analysed with descriptive statistics, Fisher’s exact tests and logistic regression. Results: Most children were breastfed (92.9%). Minimum dietary diversity was met by 77.4% (95% CI 67.4–85.0), minimum meal frequency by 80.0% and minimum acceptable diet by 62.7%. Dietary diversity rose from 54.2% at 6–8 months to 90.2% at 12–23 months (p = 0.004). Only 32.1% of children had eaten eggs, while 60.7% had eaten sweet foods. Most caregivers (81.5%) had adequate knowledge, and 97.8% knew complementary foods should start at six months, but only 10.9% chose thick porridge as best for a young child. Nearly half (45.7%) found it difficult to give varied foods each day. Knowledge was not associated with any feeding indicator. Minimum acceptable diet was associated with caregiver secondary or higher education (adjusted odds ratio [aOR] 3.85, 95% CI 1.20–12.37) and confidence in preparing food (aOR 4.19, 1.19–14.82). Conclusions: Caregivers had good knowledge and most older children had diverse diets, but infants aged 6–8 months, low egg intake, frequent sweet foods and poor knowledge of food consistency are clear gaps. Knowledge alone did not predict good practice. Counselling should build practical skills and confidence, focus on the first months of complementary feeding, and be linked with support for household food access.